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​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Influenza: Inpatient Management

 
First Line
Second Line
Antimicrobial
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Check for interactions

 

Oseltamivir

 
 
Dose
75mg every 12 hours
Route
PO
Duration
5 days

 

Note: Treatment course of oseltamivir is extended to 10 days in patients who are immunocompromised.

 

​​​Renal Impairment (dose adjustments based on renal drug database)

 

Dose reduction is required in renal impairment, see below:

Creatinine clearance
Recommended treatment dose (5 day course)
>30ml/min
75mg TWICE a day
11-30ml/min
75mg ONCE daily
<10ml/min
75mg ONCE as a single dose
Haemodialysis
30mg STAT then 30mg THREE times a WEEK after HD session  (Dialysed)
​Haemodiafiltration ​75mg THREE times a WEEK after dialysis session (Dialysed)
Peritoneal dialysis
30mg ONCE as a single dose
Haemo(dia)filtration
1-1.8L/hr exchange rate (continuous dialysis)
30mg ONCE a day
Haemo(dia)filtration
1.9-3.6 L/hr exchange rate (continuous dialysis)
30mg TWICE a day
Haemo(dia)filtration
>3.6 L/hr exchange rate
(continuous dialysis)
75mg TWICE a day

 

 

Additional Information

  • All patients requiring admission with influenza like illness should be prescribed antivirals regardless of duration of symptoms or underlying risk factors.
  • Notify patient to both Infection Control and Infectious Diseases teams.
  • Take a sample for laboratory confirmation of respiratory virus infection (Nose and Throat Swabs)



Influenza with concurrent pneumonia​

If a pat​ient is confirmed flu with clinical features of pneumonia, a decision to start antibiotics may be considered.​

 

First Line

Second Line

Third line

Allergy status
(Confirm allergy status prior to choosing antimicrobial regime)

No penicillin allergy


Mild Penicillin allergy​​​

 

Severe penicillin allergy

 

Antimicrobial

Co-amoxiclav

and

Clarithromycin*

Cefuroxime

and

Clarithromycin*

Levofloxacin**

Dose

Co-amoxiclav 1200mg

every 8 hours

and

Clarithromycin* 500mg every 12 hours

Cefuroxime 1500mg

every 8 hours

and

Clarithromycin* 500mg every 12 hours

Levofloxacin 500mg every 12 hours

Route

IV co-amoxiclav

PO clarithromycin

IV cefuroxime

PO clarithromycin

IV levofloxacin

Duration

Review at 48 -72 hours

Review at 48 -72 hours

Review at 48-72 hours


















































​Additional Information 
  • Clarithromycin is well absorbed from the gastro-intestinal tract, and when given intravenously can cause thrombophlebitis. 
  • IV clarithromycin can be prescribed if a patient is nil by mouth or if there are concerns of impaired gastro-intestinal absorption. 
  • *Clarithromycin is a potent enzyme inhibitor and interacts with many drugs.  Please check the BNF for information on drug interactions and discuss with pharmacy​.

** Levofloxacin is ineffective if given with multi-valent cation containing products e.g. antacids, supplements or feeds containing calcium, iron, magnesium, zinc, sucralfate or bismuth. These products bind to doxycycline and reduce its absorption by up to 90%.

 If patients are prescribed antacids or supplements containing calcium iron, magnesium zinc or bismuth. It is advised these medications are stopped/withheld for the duration of antibiotic treatment. If this is not possible due to a clinical need, then an alternative antibiotic must be considered

If doxycycline/ciprofloxacin and a cation containing product must be prescribed together:

·         Administration times should be as far apart as possible

·         Reduce the dosing frequency of the interacting product if possible

·         In the case of oral nutritional supplements, multiple sips throughout the day should be replaced with set administration times to enable adequate spacing from oral antibiotic administration

·         If a patient is receiving an enteral feed doxycycline should generally be avoided unless there is a specific feed free window 




IV to PO arrow.png 
 

Oral stepdown if successful treatment response:

 

 

First Line

Second Line

Allergy status
(Confirm allergy status prior to choosing antimicrobial regime)

No penicillin allergy

Penic​illin allergy

Antimicrobial

Amoxicillin

and

Clarithromycin 

Clarithromycin* 

Dose

 Amoxicillin 1000mg every 8 hours

and

Clarithromycin* 500mg every 12 hours

Clarithromycin 500mg every 12 hours

Route

 PO

 PO

Duration

7 -10 days total (including IV therapy)​​


*Clarithromycin is a potent enzyme inhibitor and interacts with many drugs.  Please check the BNF for information on drug interactions and discuss with pharmacy​.​