Treatment of Influenza with Severe Pneumonia or Acute Respiratory Distress Syndrome in Hospitalised Patients

This protocol addresses influenza management when patients require hospitalisation for severe lower respiratory tract disease. It applies to individuals of any age admitted with influenza, regardless of how long symptoms were present before hospital arrival.

The clinical scenario involves influenza complicated by one or more of the following: pneumonia, respiratory failure, or acute respiratory distress syndrome (ARDS). These presentations define the severe lower respiratory tract disease setting for which this protocol is intended.

Clinical Approach

When a hospitalised influenza patient fails to improve — or deteriorates — despite antiviral therapy, the protocol calls for evaluating alternative infectious causes and performing influenza antiviral resistance testing. Depending on resistance findings, early adjustment to a different antiviral agent may be indicated. The full algorithm, specific agent selection criteria, and sequencing are detailed in the structured protocol…

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References

DOI: 10.1093/cid/ciy866

Persons of any age who are hospitalized with influenza, regardless of illness duration prior to hospitalization (A-II).
In hospitalized adults, oseltamivir is the preferred antiviral drug because data are very limited on inhaled zanamivir in severely ill influenza patients.
Clinicians should investigate other causes besides influenza virus infection in influenza patients who fail to improve or deteriorate despite antiviral treatment (A-III).
The best outcomes appear to be associated with early change in antiviral therapy to an agent with in vitro activity against the oseltamivir-resistant influenza virus.

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