Management of Influenza A with Elevated CRP

Initial Assessment and Risk Stratification

The American Thoracic Society recommends checking vital signs, including temperature, respiratory rate, pulse, blood pressure, mental status, and oxygen saturation, to assess disease severity in patients with influenza A 1, 2, 3
The British Thoracic Society suggests calculating the CURB-65 score (or CRB-65 in community settings) for patients with suspected pneumonia, scoring 1 point each for: Confusion, Urea >7 mmol/L, Respiratory rate ≥30/min, Blood pressure (SBP <90 or DBP ≤60 mmHg), age ≥65 years 4, 5, 6
The European Respiratory Society recommends examining for bilateral chest signs (crackles), which indicate primary viral pneumonia and warrant hospital referral regardless of CURB-65 score 6, 7

The Infectious Diseases Society of America recommends starting oseltamivir immediately if the patient meets ALL of the following criteria: acute influenza-like illness present, fever >38°C (or inability to mount fever if immunocompromised/elderly), and symptomatic for ≤48 hours 1, 2, 8
The Centers for Disease Control and Prevention suggest dosing oseltamivir 75 mg orally twice daily for 5 days (reduce to 75 mg once daily if creatinine clearance <30 mL/min) 1, 7, 8

The American College of Physicians recommends considering antibiotics for patients with pneumonia, with the decision to use antibiotics depending on pneumonia presence and patient risk status 9, 1, 10
The British Medical Association suggests starting empiric antibiotics, such as oral co-amoxiclav or doxycycline, for patients with non-severe pneumonia (CURB-65 0-2) 8
The European Society of Clinical Microbiology and Infectious Diseases recommends starting IV antibiotics, such as co-amoxiclav or second/third generation cephalosporin, for patients with severe pneumonia (CURB-65 3-5 OR bilateral CXR changes) 8

The American Thoracic Society recommends providing oxygen therapy for hypoxic patients, targeting PaO2 >8 kPa and SaO2 ≥92% 9, 1, 2, 11
The European Respiratory Society suggests assessing and managing fluid status, evaluating for volume depletion and cardiac complications, and providing IV fluids as needed 9, 1, 2, 4, 5

The Infectious Diseases Society of America recommends monitoring vital signs at least twice daily, more frequently if severe, including temperature, respiratory rate, pulse, blood pressure, mental status, oxygen saturation, and inspired oxygen concentration 9, 1, 2, 11

The American College of Emergency Physicians suggests admitting patients who have ≥2 of the following unstable clinical factors: temperature >37.8°C, heart rate >100/min, respiratory rate >24/min, systolic blood pressure <90 mmHg, oxygen saturation <90%, inability to maintain oral intake, or abnormal mental status 9, 1, 2, 11