Influenza Management Guidelines

Antiviral Treatment

The American Thoracic Society recommends oseltamivir 75 mg orally twice daily for 5 days as the first-line antiviral treatment for influenza in adults and adolescents, initiated ideally within 48 hours of symptom onset 1, 2
Antiviral treatment should be offered to patients who meet ALL of the following criteria: acute influenza-like illness, fever >38°C in adults (>38.5°C in children), and symptomatic for ≤48 hours 1, 2, 3
The American Academy of Pediatrics recommends that regardless of timing or vaccination status, initiate antivirals immediately for any hospitalized patient with suspected or confirmed influenza, patients with severe, complicated, or progressive illness, and children or adults at high risk of complications 4, 2
Antiviral therapy provides reduction in illness duration by approximately 24 hours, possible reduction in hospitalization rates, decreased use of subsequent antibiotics, and faster return to normal activity levels 1, 3, 5

The Infectious Diseases Society of America recommends that previously well adults with acute bronchitis complicating influenza do NOT routinely require antibiotics in the absence of pneumonia 6, 1, 2, 5
Patients at high risk of complications should be strongly considered for antibiotics when lower respiratory tract features are present, even without confirmed pneumonia 6, 1, 2, 5, 8
The American Thoracic Society recommends that all patients with influenza-related pneumonia require antibiotics, initiated within 4 hours of hospital admission 6, 2, 8
Immediate parenteral combination antibiotic therapy is required upon diagnosis of severe influenza-related pneumonia 6, 2, 5, 8

The American Academy of Pediatrics recommends never delaying antiviral treatment while awaiting laboratory confirmation—clinical diagnosis is sufficient, and early treatment (within 24 hours) provides maximum benefit 7
The Centers for Disease Control and Prevention recommends avoiding aspirin in children with influenza due to risk of Reye syndrome 6, 5
The Infectious Diseases Society of America recommends remembering that influenza-related pneumonia requires coverage for S. aureus in addition to typical community-acquired pneumonia pathogens 1, 8