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December 26, 2018

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Updated IDSA Flu Guidelines Now Available

Pregnant women and the extremely obese are among those at high risk for complications from the flu – including death – and should be tested and begin antiviral treatment promptly if they are sick enough to be hospitalized with flu symptoms, according to updated IDSA guidelines published in Clinical Infectious Diseases. Outpatients who have been diagnosed with the flu and are at high risk for complications should also be provided antiviral treatment as soon as possible.

The guidelines recommend using newer and highly accurate molecular tests that deliver results in 15-60 minutes instead of rapid-influenza diagnostic tests (RIDTs), which produce quick results but can be falsely negative in at least 30 percent of outpatients with influenza. While antiviral treatment is recommended within two days after the start of flu symptoms in people who aren’t at high risk for complications, the guidelines note they should be prescribed to those at high risk even if they have been sick for more than two days.

People who are extremely obese have a body mass index (BMI) of 40 or more. Others in the high-risk category include: young children (especially those younger than 2 years old); women who have recently given birth; those with a weakened immune system due to disease or medication (such as people with HIV or AIDS, cancer, who have had an organ transplant or who are on chronic steroids); people younger than 19 years old who are receiving long-term aspirin therapy; those with chronic medical conditions including asthma, neurological or neurodevelopmental disorders (such as cerebral palsy, epilepsy and stroke), heart or lung disease, kidney, liver or metabolic disorders; and nursing home residents; American Indians and native Alaskans.

The guidelines also note that antiviral treatment should be started immediately in people at high risk of flu complications who are being admitted to the hospital with suspected influenza, without waiting for the results of molecular influenza testing. Influenza testing is important because physicians are more likely to treat patients with antiviral medications if they have a definitive diagnosis, further reducing the likelihood of prescribing antibiotics inappropriately, especially in outpatients. If people at high risk become seriously ill with influenza, health care providers should turn to infectious diseases (ID) doctors to provide expertise, the guidelines note.

In addition to co-chairs Timothy M. Uyeki, MD, MPH, MPP, and Andrew T. Pavia, MD, FIDSA the guidelines panel includes: Henry H. Bernstein, DO, MHCM; John S. Bradley, MD, FIDSA; Janet A. Englund, MD, FIDSA; Thomas M. File Jr., MD, MSc, FIDSA; Alicia M. Fry, MD; Stefan Gravenstein, MD, MPH; Frederick G. Hayden, MD, FIDSA; Scott A. Harper, MD, MSc, MPH; Jon Mark Hirshon, MD, PhD; Michael G. Ison, MD, MS, FIDSA; B. Lynn Johnston, MD, FIDSA; Shandra L. Knight; Allison McGeer, MD, FIDSA; Laura E. Riley, MD; Cameron R. Wolfe, MBBS, MPH, FIDSA and Paul E. Alexander, MSc, MHSc, PhD.

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