Influenza Management Guidelines

Antiviral Treatment

The American Academy of Pediatrics recommends starting oseltamivir 75 mg orally twice daily for 5 days immediately for any hospitalized patient with suspected or confirmed influenza, any patient with severe/complicated/progressive illness, and all high-risk patients, regardless of vaccination status or timing of presentation 1, 2
High-risk patients, including those with asthma, diabetes, immunosuppression, chronic cardiac/pulmonary disease, neurologic disorders, pregnancy, age <2 years or >65 years, should receive antiviral treatment 1, 3
Treatment reduces illness duration by approximately 24 hours, decreases hospitalization rates, reduces antibiotic use, and hastens return to normal activity 2

Pregnant women should receive inactivated influenza vaccine at any time during pregnancy, and oseltamivir is safe and should be used for treatment when indicated 1
Women in the postpartum period who did not receive vaccination during pregnancy should receive vaccine before hospital discharge, and influenza vaccination during breastfeeding is safe for mothers and infants 1
Children with egg allergy can receive influenza vaccine (IIV or LAIV) without any additional precautions beyond those recommended for all vaccines 1

The British Thoracic Society recommends that previously healthy adults with acute bronchitis complicating influenza do NOT routinely require antibiotics in the absence of pneumonia 6, 2, 4
First-line oral therapy for non-severe influenza-related pneumonia is co-amoxiclav or tetracycline, with alternative options including macrolide or fluoroquinolone with pneumococcal and staphylococcal activity 6, 4
Immediate parenteral combination therapy is required upon diagnosis of severe influenza-related pneumonia, with a preferred regimen of IV co-amoxiclav or 2nd/3rd generation cephalosporin PLUS macrolide 6, 2, 4

The American Academy of Pediatrics recommends antiviral chemoprophylaxis after known or suspected influenza exposure in high-risk children for whom influenza vaccine is contraindicated, during the 2 weeks after influenza vaccination, and for unvaccinated family members or healthcare personnel with ongoing close exposure to unvaccinated high-risk children or unvaccinated infants/toddlers <24 months 1, 3

Never delay antiviral treatment while awaiting laboratory confirmation—clinical diagnosis is sufficient 2
Never use aspirin in children with influenza due to risk of Reye syndrome 2
Never prescribe zanamivir to patients with any underlying airways disease (asthma, COPD), regardless of severity 5
Never withhold oseltamivir from high-risk or hospitalized patients even if presenting beyond 48 hours, as they may still benefit significantly 1, 3
Never rely on negative rapid antigen tests to rule out influenza or guide treatment decisions—they have low sensitivity 3
Always remember to cover S. aureus when treating influenza-related pneumonia with antibiotics 2, 4