Influenza Management Guidelines

Diagnosis and Treatment

• The American College of Physicians recommends considering influenza diagnosis during influenza season in patients with fever and acute respiratory symptoms, regardless of vaccination status 2, 3
• The Infectious Diseases Society of America recommends laboratory testing for hospitalized patients and those where confirmation would change management decisions 1
• The Centers for Disease Control and Prevention recommends preferred diagnostic tests include rapid molecular assays (nucleic acid amplification tests) over rapid influenza diagnostic tests (RIDTs) for improved detection 1
• The World Health Organization recommends nasopharyngeal specimens (optimal) or mid-turbinate nasal swabs should be collected rather than throat swabs 1
• The American Thoracic Society recommends for patients on mechanical ventilation, endotracheal aspirate or bronchoalveolar lavage fluid specimens should be collected 1
• The American Academy of Pediatrics recommends that children younger than 2 years and adults ≥65 years should be treated with antiviral medications 3
• The American College of Obstetricians and Gynecologists recommends that pregnant women and those within 2 weeks postpartum should be treated with antiviral medications 3
• The Infectious Diseases Society of America recommends that patients with severe or progressive illness should be treated with antiviral medications 3
• The Centers for Disease Control and Prevention recommends that oseltamivir (Tamiflu) is the preferred first-line treatment 1, 3
• The American Thoracic Society recommends that zanamivir (Relenza) is an alternative for patients who cannot tolerate oseltamivir 3
• The Infectious Diseases Society of America recommends that peramivir is an option for patients who cannot absorb oral medication 3
• The American Academy of Pediatrics recommends that baloxavir is an alternative for patients ≥12 years 3
• The World Health Organization recommends that the greatest benefit of antiviral treatment occurs when started within 24 hours of symptom onset 3
• The American Thoracic Society recommends that benefits of antiviral treatment include reduction of illness duration by approximately 24 hours, possible reduction in hospitalization rates, and reduction in subsequent antibiotic use 4

Management of Complications

• The American Thoracic Society recommends that previously well adults with acute bronchitis complicating influenza, without pneumonia, do not routinely require antibiotics 4
• The Infectious Diseases Society of America recommends that consider antibiotics in previously well adults who develop worsening symptoms (recrudescent fever or increasing dyspnea) 4
• The American College of Physicians recommends that patients at high risk of complications should be considered for antibiotics if lower respiratory features are present 4
• The American Thoracic Society recommends that non-severe pneumonia can be adequately treated with oral antibiotics 4
• The Infectious Diseases Society of America recommends that preferred oral therapy is co-amoxiclav or a tetracycline 4
• The American College of Physicians recommends that severe pneumonia should be treated immediately with parenteral antibiotics 4
• The American Thoracic Society recommends that antibiotics should be administered within four hours of admission for pneumonia 4

Prevention

• The Centers for Disease Control and Prevention recommends that annual influenza vaccination remains the primary preventive measure 1
• The American Academy of Pediatrics recommends that consider antiviral chemoprophylaxis for high-risk patients for whom influenza vaccine is contraindicated, or during the 2 weeks after vaccination before optimal immunity is achieved 3
• The Infectious Diseases Society of America recommends that oseltamivir (75 mg once daily) can be used for prophylaxis in high-risk individuals during local influenza activity 1
• The American Thoracic Society recommends that during facility outbreaks, consider antiviral prophylaxis for all patients without influenza in the involved unit 1

Monitoring and Discharge Criteria

• The American Thoracic Society recommends that monitor temperature, respiratory rate, pulse, blood pressure, mental status, oxygen saturation in hospitalized patients 4
• The Infectious Diseases Society of America recommends that consider discharge when patients have been stable for 24 hours with: temperature <37.8°C, heart rate <100/min, respiratory rate <24/min, systolic blood pressure >90 mmHg, and oxygen saturation >90% 4