Patients with influenza who have an immunocompromising condition or are receiving immunosuppressive therapy represent a clinically distinct, high-risk group. Managing influenza in this population requires a tailored antiviral approach guided by specific evidence-based criteria.

This protocol addresses influenza occurring in the setting of an immunocompromising condition or active immunosuppression. Immunocompromised patients — along with those with chronic medical conditions — are at elevated risk of serious complications from influenza and are prioritised for structured antiviral management.

The approach in this setting includes evaluation for influenza antiviral resistance, and the treatment strategy may involve switching to an inhaled antiviral agent when resistance is a concern. Combination antiviral therapy using agents with differing mechanisms may also factor into management decisions.

Full decision criteria, sequencing, and complete protocol available below.

References

DOI: 10.1093/cid/ciy866

Outpatients who are at high risk of complications from influenza, including those with chronic medical conditions and immunocompromised patients (A-II).
In general, influenza patients who were treated with oseltamivir and are suspected of developing oseltamivir resistance should be switched to inhaled zanamivir, unless contraindicated.
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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Treatment of Influenza in Immunocompromising Conditions and Immunosuppression