Treatment of Outpatients with Influenza
Patient Selection for Antiviral Treatment
- The Infectious Diseases Society of America recommends that all outpatients at high risk for influenza complications should receive immediate antiviral treatment with a neuraminidase inhibitor as soon as influenza is suspected, without waiting for diagnostic confirmation, and treatment should not be delayed beyond 48 hours of symptom onset 1, 2
- The Centers for Disease Control and Prevention suggests that children younger than 2 years, adults ≥65 years of age, pregnant women and those within 2 weeks postpartum, immunocompromised patients, and patients with chronic medical conditions require immediate antiviral therapy regardless of illness duration or vaccination status 1, 2, 4
- The American College of Physicians recommends that outpatients with severe or progressive illness of any duration should receive antiviral treatment 1, 2
Antiviral Medications and Dosing
- The Infectious Diseases Society of America recommends using a single neuraminidase inhibitor, such as oseltamivir 75 mg orally twice daily for 5 days, as first-line treatment for influenza 1, 2
- The Centers for Disease Control and Prevention suggests that zanamivir and peramivir are alternative options for antiviral treatment 1, 2
Diagnostic Testing Approach
- The Infectious Diseases Society of America recommends using RT-PCR or other molecular assays for diagnostic testing, rather than rapid influenza diagnostic tests or immunofluorescence assays 1, 2, 5
Managing Bacterial Coinfection
- The Infectious Diseases Society of America recommends empirically adding antibiotics to antiviral therapy in patients with severe initial disease, clinical deterioration, or failure to improve after 3-5 days of antiviral treatment 1, 2, 3, 5
- The American Thoracic Society suggests that doxycycline or co-amoxiclav are preferred regimens for antibiotic treatment of influenza-related pneumonia 6