Influenza - Management of Infection Guidance for Primary Care

Publication: 30/09/2010  --
Last review: 01/01/1900  
Next review: 01/04/2018  
Clinical Guideline
UNDER REVIEW 
ID: 2229 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2010  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Influenza

Illness

Comments

Preferred option

Alternative

Influenza
HPA Influenza
The Green Book

Annual vaccination is essential for all those at risk of influenza.  For otherwise healthy adults, anti-virals are not recommended. Treat ‘at risk’ patients, only when influenza is circulating in the community or in a care home where influenza is likely, within 48 hours of onset. At risk:  65 years or over, chronic respiratory disease (including COPD and asthma) significant cardiovascular disease (not hypertension), immuno-compromised, diabetes mellitus, chronic neurological, renal or liver disease.  Use oseltamivir 75 mg oral capsule BD (for OD prophylaxis see (NICE Influenza) or zanamivir 10 mg (2 inhalations by diskhaler) BD for 5 days if there is resistance to oseltamivir. Patients under 13 years see HPA influenza link attached.

Pharmacological treatment & Prophylaxis of influenza - HPA Guidance

Principles of Treatment

  1. This guidance is based on the best available evidence but its application must be modified by professional judgement.
  2. A dose and duration of treatment is suggested. In severe or recurrent cases consider a larger dose or longer course
  3. Choices are given as Preferred option or Alternative for patients intolerant of the preferred option and 2nd Line for when an alternative is required because of treatment failure
  4. Only send microbiology specimens if there is a clinical suspicion of infection. Inappropriate specimens (e.g. routine ulcer swab or routine catheter specimen of urine) lead to inappropriate antibiotic prescribing.
  5. Prescribe an antibiotic only when there is likely to be a clear clinical benefit.
  6. Consider a no, or delayed, antibiotic strategy for acute self-limiting upper respiratory tract infections 1,A+
  7. Limit prescribing over the telephone to exceptional cases.
  8. Use simple generic antibiotics if possible. Avoid broad spectrum antibiotics (e.g. co-amoxiclav, quinolones and cephalosporins) when narrow spectrum antibiotics remain effective, as they increase risk of Clostridium difficile, MRSA and resistant UTI's.
  9. Avoid widespread use of topical antibiotics (especially those agents also available as systemic preparations).
  10. In pregnancy AVOID tetracyclines, aminoglycosides, quinolones, and high dose metronidazole. Short-term use of trimethoprim (unless low folate status or taking another folate antagonist such as antiepileptic or proguanil) or nitrofurantoin (at term, theoretical risk of neonatal haemolysis) is unlikely to cause problems to the foetus.
  11. We recommend clarithromycin as it has less side-effects than erythromycin, greater compliance as twice rather than four times daily & generic tablets are similar cost. In children erythromycin may be preferable as clarithromycin syrup is twice the cost.
  12. Where a ‘best guess’ therapy has failed or special circumstances exist, microbiological advice can be obtained from LTHT Microbiology (Mon-Fri 9am-5pm and Sat and Sun 9am-1pm: 0113 39 23962/28580; Otherwise via LTHT switchboard - ask for the On call Microbiology Registrar)

Note

Note: Doses are oral and for adults unless otherwise stated. Please refer to BNF for further information.
Letters indicate strength of evidence:
A+ = systematic review: D = informal opinion

Provenance

Record: 2229
Objective:
  • to provide a simple, empirical approach to the treatment of common infections
  • to promote the safe, effective and economic use of antibiotics
  • to minimise the emergence of bacterial resistance and reduce the incidence of Healthcare Associated Infections in the community
Clinical condition:

Infulenza

Target patient group:
Target professional group(s): Primary Care Doctors
Pharmacists
Adapted from:

This guidance was initially developed in 1999 by practitioners in South Devon, as part of the S&W Devon Joint Formulary Initiative, and Cheltenham & Tewkesbury Prescribing Group and modified by the PHLS South West Antibiotic Guidelines Project Team, PHLS Primary Care Co-ordinators and members of the Clinical Prescribing Sub-group of the Standing Medical Advisory Committee on Antibiotic Resistance. It was further modified following comments from Internet users. The guidance has been updated annually as significant research papers, systematic reviews and guidance have been published. The Health Protection Agency works closely with the authors of the Clinical Knowledge Summaries.


Evidence base

Grading of guidance recommendations

The strength of each recommendation is qualified by a letter in parenthesis.

Study design

Recommendation
grade

Good recent systematic review of studies

A+

One or more rigorous studies, not combined

A-

One or more prospective studies

B+

One or more retrospective studies

B-

Formal combination of expert opinion

C

Informal opinion, other information

D

Clinical Knowledge Summaries web http://www.prodigy.nhs.uk. BNF (No 55), SMAC report - The path of least resistance (1998), SDHCT Medical Directorate guidelines + GU medicine guidelines, Plymouth Management of Infection Guidelines project LRTI and URTI.

Self-limiting upper respiratory tract infections

  1. NICE 69: National Institute for Health and Clinical Excellence. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. 2008. (Clinical guideline 69)

Influenza

  1. National Institute for Health and Clinical Excellence. Amantadine, oseltamivir and zanamivir for the treatment of influenza (review of NICE technology appraisal guidance 58) http://www.nice.org.uk/nicemedia/pdf/TA168quickrefguide.pdf Accessed 25.03.09
  2. Oseltamivir resistance in European influenza viruses. Health Protection Agency 2008.
  3. Turner D, Wailoo A, Nicholson K , Cooper N, Sutton A, Abrams K. Systematic review and economic decision modelling for the prevention and treatment of influenza A and B. Health Technology Assessment 2003;7(35):iii-iv, xi-xiii, 1-170.

Document history

LHP version 1.0

Related information

Not supplied