Antiviral treatment may have some value for hospitalized patients when started even 5 days after symptom onset. Treatment may be extended beyond the usual recommendations (5 days for oseltamivir or zanamivir) in immunosuppressed patients or the critically ill. Additionally, recent guidelines include consideration of antiviral treatment in outpatients who are at normal risk if treatment can be started within 48 hours of symptom onset.14
The CDC currently recommends use of oseltamivir rather than other antivirals for most hospitalized patients, based on the availability of data on its use in this setting.14 Intravenous peramivir is recommended for patients who cannot tolerate or absorb oral medication; inhaled zanamivir or IV peramivir are preferred for patients with end-stage renal disease who are not undergoing dialysis (see Table 3).14
Strategy 2: Exercise caution when it comes to supportive care
There are other medications that may offer symptom relief or prevent complications, especially when antivirals are contraindicated or unavailable.
Corticosteroids are recommended as part of the treatment of community-acquired pneumonia,20 but their role in influenza is controversial. A 2016 Cochrane review21 found no randomized controlled trials on the topic. Although the balance of available data from observational studies indicated that use of corticosteroids was associated with increased mortality, the authors also noted that all the studies included in their meta-analysis were of “very low quality.” They concluded that “the use of steroids in influenza remains a clinical judgement call.”
Offering vaccination by the end of October, if possible, is recommended in order for immunity to develop by mid-November.
Statinsmay be associated with improved outcomes in influenza and pneumonia. Studies thus far have given contradictory results,22,23 and a planned Cochrane review of the question has been withdrawn.24
