Algorithm For Treatment of ILI In Adult Patients With Co-morbidities In An Outpatient Setting
# Definition of Influenza-like Illness (ILI):
Sudden onset of fever with temperature > 38°C with cough and sore throat, in the absence of other diagnosis
* Treatment with influenza antivirals:
Treatment with the antiviral drugs should be administered as soon as possible after symptom onset. As the benefits are greatest when administered within 48 hours after symptom onset, clinicians should initiate treatment immediately and not wait for the results of laboratory tests.
While treatment within 48 hours of symptom onset brings the greatest benefits, later initiation of treatment may also be beneficial. This decision should be made on a case-by-case basis. If the symptoms are improving beyond the first 48 hours, treatment may not be necessary. Clinical benefits associated with oseltamivir treatment include a reduced risk of pneumonia (one of the most frequently reported causes of death in infected people) and a reduced need for hospitalization.
** Clinical assessment Tool:
Patients with ILI and any of the following parameters should be considered for admission to the of nearest hospital
Respiratory impairment: any of the following
Tachypnoea, respiratory rate > 24/min
Inability to complete sentence in one breath
Use of accessory muscles of respiration, supraclavicular recession
Oxygen saturation ≤ 92% on pulse oximetry
Decreased effort tolerance since onset of ILI
Evidence of clinical dehydration or clinical shock
Systolic BP <>
Capillary refill time > 2 seconds, reduced skin turgor
Altered Conscious level (esp. in extremes of age)
New confusion, striking agitation or seizures
Other clinical concerns:
Rapidly progressive (esp. high fever > 3 days) or serious atypical illness
Severe & persistent vomiting
*** Home assessment Tool:
Respiratory Difficulties: Shortness of breath, rapid breathing or Purple or blue discoloration of lips
Coughing out blood or blood streaked sputum
Persistent chest pains
Persistent diarrhea and / or vomiting
Fever persisting beyond 3 days or recurring after 3 days
Abnormal behaviour , confusion, less responsive , convulsion
Dizziness when standing and/or reduced urine production
@ Co-morbidities / Risk factors: Patients who are considered vulnerable to severe outcomes and should be a focus of early identification, assessment and treatment, include the following:
Chronic respiratory conditions, including asthma, COPD, Obstructive sleep apnoea
Pregnant women, esp. in second or third trimester
Other possible predisposing conditions, such as chronic cardiac disease (not simple hypertension), and chronic illnesses including diabetes mellitus, renal failure, haemoglobinopathies, immunosuppression (including cancer, HIV/AIDS, chemotherapy, long term steroids).
Adults > 65 years of age esp. those with other chronic diseases
As more epidemiologic and clinical data become available, these risk groups might be revised.
Zanamivir Zanamivir is not advised in patients with history of bronchospasm.