flu treat
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"influenza"[MeSH Terms] AND "antiviral treatment"[MeSH Terms]
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"influenza"[MeSH Terms] AND "antiviral agents"[MeSH Terms]
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Here is a concise, evidence-based overview of flu (influenza) treatment:
Influenza Treatment
Supportive Care (all patients)
- Rest and hydration - the backbone of management
- Antipyretics/analgesics: acetaminophen or ibuprofen for fever, myalgia, and headache
- Avoid aspirin in children and adolescents (risk of Reye syndrome)
Antiviral Therapy
Who should be treated?
Antivirals are indicated for:
- All hospitalized patients
- Patients with severe influenza (e.g., pneumonia)
- Patients at high risk for complications: elderly, pregnant women, immunocompromised, those with chronic cardiopulmonary/metabolic disease, nursing home residents
- Patients without risk factors who present within 48 hours and want to shorten illness duration
Start antivirals as soon as possible - do not delay waiting for test results when treatment is indicated.
Timing
- Best within 48 hours of symptom onset
- May still benefit hospitalized/high-risk patients up to 5 days after onset
- Hospitalized patients may benefit up to 96 hours after onset
Antiviral Drug Options
| Drug | Route | Notes |
|---|---|---|
| Oseltamivir (Tamiflu) | Oral | First-line; reduce dose 50% if CrCl <30 mL/min; side effects: nausea/vomiting |
| Zanamivir (Relenza) | Inhaled | Avoid in asthma/COPD (risk of bronchospasm) |
| Peramivir | IV (single 600 mg dose) | Alternative for uncomplicated flu, symptoms <2 days |
| Baloxavir (Xofluza) | Oral | Inhibits influenza RNA polymerase endonuclease; approved 2018 for uncomplicated flu A/B; also for high-risk patients; start within 48 hours |
All antivirals reduce illness duration by roughly 0.5-1.5 days and reduce complication rates.
Neuraminidase inhibitors (oseltamivir, zanamivir):
- Reduce symptom severity and duration by ~1 day
- Oseltamivir also reduces lower respiratory tract infections requiring antibiotics (NNT 22), pneumonia (NNT 90), and hospitalizations (NNT 91)
- Neuraminidase inhibitors are effective for both influenza A and B
Resistance note:
- A 2008-2009 H1N1 strain showed near-universal oseltamivir resistance; CDC recommended combining with rimantadine or using zanamivir alone
- Current H3N2 and influenza B: oseltamivir alone is appropriate
Influenza with Pneumonia
Add antibacterial coverage targeting S. pneumoniae and S. aureus (including MRSA) alongside antiviral therapy.
Prophylaxis (Post-Exposure)
- Oseltamivir and zanamivir are both effective as prophylaxis (e.g., nursing home outbreaks)
- Baloxavir is also more effective prophylactically for household contacts
Annual Flu Vaccine
Prevention remains the most effective strategy. The CDC recommends vaccination annually for everyone 6 months and older.
Sources: Symptom to Diagnosis, 4th Ed. | Sherris & Ryan's Medical Microbiology, 8th Ed. | Harriet Lane Handbook, 23rd Ed.
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