Influenza antivirals: who needs them, and what they really do

The edition in brief

As influenza season approaches, a review for family physicians sets out where antivirals fit. Most people with flu do not need them. Treatment should start promptly for anyone hospitalised, severely or progressively ill, or at high risk of complications, and can be considered for symptomatic household contacts of high-risk people and for health workers. Started within 24 to 36 hours, antivirals shorten symptoms by about 20 hours, with little evidence that they prevent complications. A negative rapid test does not exclude flu, and annual vaccination from six months of age, including in pregnancy, remains the main defence. A second review treats alcohol use disorder as a common chronic condition: screen with a short validated tool such as AUDIT-C, assess the liver and withdrawal risk, offer brief counselling to everyone with the disorder, and treat or refer, including for co-existing mental illness. From Singapore, a five-year matched analysis found that splitting polyclinics into small teams of two family physicians, a nurse and a care coordinator raised foot screening by 16% and eye screening by 6%, cut hospital admissions, and saved about SGD 2,186 per patient, though changes in HbA1c and blood pressure were small. The pearl covers using AUDIT-C in a short consultation.