Influenza Treatment

Patients with suspected influenza should be isolated and respiratory precautions commenced – see here for advice.
If potential Avian Influenza (e.g. History of working with poultry, travel to USA, SE or South Asia), Discuss urgently with Micro/ID; see Triage of HCID For ED HCID triage poster, see here.
The REMAP CAP trial includes randomisation of patients to oseltamivir. When prescribing for patients in the trial use the REMAP CAP trial PowerPlan on EPR.
Be aware if testing (particularly by PCR), if vaccinated within 14 days with Live Attenuated Influenza Vaccine (LAIV), may produce a false positive – if clinically consistent with influenza, then manage as such.
Please ensure vaccination history taken. Note that children in risk groups can be offered vaccination from 6 months of age

For neonatal exposure, discuss with Paeds ID.

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Risk factors for severe influenza and hospitalisation (at risk population)

Chronic neurological, hepatic, renal, respiratory and cardiovascular diseases requiring frequent hospitalisation/follow up
Potential Immunosuppression*
Children under 6 months of age in unvaccinated mothers
Prematurity within last 6 months

*see NICE TA 168 includes:-

Primary immunodeficiency - not on replacement therapy
Current or recent (within 6 months) chemotherapy or radiotherapy for malignancy,
Solid organ transplant recipient currently receiving immunosuppressive treatment
Bone marrow transplant recipient currently receiving immunosuppressive treatment or within 12 months of receiving immunosuppression,
Patients with current Graft vs host disease (GVHD),
Patients currently receiving high dose systemic corticosteroids 2mg/kg/day or more for 1 week or longer, and for at least 3 months after this length of treatment has stopped
People living with HIV with severe immunosuppression on discussion with Paeds ID team.
Patients currently or recently (within 6 months) on other types of highly immunosuppressive therapy or where the patient’s specialist regards them as severely immunosuppressed

No antiviral treatment required

Start within 48 hours of illness onset for the greatest benefit. Evidence beyond 48 hours of onset is limited.

First line treatment: Oseltamivir po, see dosing table below, for 5 days (10 days for immunosuppressed and/or critically ill patients in PCC, discuss with Paeds ID)

Oseltamivir treatment dose:

Age	Oseltamivir treatment dose
Infants under 12 months (36 weeks post conceptional age or greater)	3mg/kg BD (max. per dose 30mg)
1–12 years (10-15kg)	30mg BD
1–12 years (more than 15kg to 23kg)	45mg BD
1–12 years (more than 23kg to 40kg)	60mg BD
1–12 years (more than 40kg)	75mg BD
13–17 years (up to 41kg)	60mg BD
13–17 years (41kg and above)	75mg BD

Dosing in Renal impairment: Discuss with pharmacist

Where oseltamivir is not tolerated or there is a poor clinical response: Discuss with Paeds ID.

Note: Treatment may also be considered to reduce transmission to severely immunosuppressed household contacts

Eligibility for treatment

Non-severe influenza, previously healthy patient

Severe influenza OR Non-severe and at risk population

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