This review for family physicians, timed for the influenza season, brings together current evidence and recommendations on prevention, diagnosis and treatment.
Annual vaccination is recommended from six months of age, including in pregnancy. Point-of-care testing in selected patients increases antiviral prescribing and reduces antibiotic use when positive, but a negative rapid test does not rule flu out. Most people with influenza do not need antivirals. Treatment should start promptly in anyone hospitalised, severely or progressively unwell, or at high risk of complications, and can be considered for symptomatic household contacts of high-risk people and symptomatic health workers. Post-exposure prophylaxis can be considered for those at risk of complications.
Oseltamivir and baloxavir are the usual options. Started within 24 to 36 hours, they shorten symptoms by about 20 hours, with little to no evidence that they reduce complications. That is a useful framing for a conversation with an otherwise healthy patient asking for 'something to cure the flu'. Oseltamivir is widely available in India; baloxavir's availability here is unknown.
- Start antivirals promptly for patients who are hospitalised, severely ill or at high risk of complications.
- For healthy adults, explain that antivirals shorten illness by about a day and are optional.
- Do not rely on a negative rapid test to exclude influenza in a high-risk patient.
- Avoid antibiotics for uncomplicated flu.
- Recommend annual vaccination, including in pregnancy, before the season peaks.
Why it matters
Matching antiviral use to risk saves drugs for those who need them and avoids promising benefits that have not been shown.
Don't overread it
The lack of proven effect on complications applies mainly to low-risk outpatients, not to high-risk or hospitalised patients.
The statistics, in plain English
A 20-hour reduction in symptoms is an average; some people benefit more, some not at all. 'Little to no evidence' on complications means trials have not shown that antivirals prevent pneumonia or hospital admission in otherwise healthy people.
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