How To Treat The Flu

Influenza is a viral infection that attacks your respiratory system — your nose, throat and lungs. Influenza is commonly called the flu, but it's not the same as stomach "flu" viruses that cause diarrhea and vomiting.

For most people, influenza resolves on its own. But sometimes, influenza and its complications can be deadly.

Initially, the flu may seem like a common cold with a runny nose, sneezing and sore throat. But colds usually develop slowly, whereas the flu tends to come on suddenly. And although a cold can be a nuisance, you usually feel much worse with the flu. 

Common signs and symptoms of the flu:

  • Abrupt illness onset
  • Viral prodrome (cytokine response leads to primary symptoms)High fever to 104 F (fever lasts 4-5 days)
  • Severe myalgias (muscle pain) (lasts for first 3 days)
  • Severe Headache (most severe in first 2 days)
  • Chills
  • Eye Photophobia (sensitivity to light)
  • Red, Burning eyes
  • Nose Coryza (watery discharge) or profuse Nasal discharge (lasts 6-7 days) Often onset with fever and no other symptoms
  • Rhinitis
  • Nasal congestion or "stuffiness"
  • Sore Throat or dry throat (lasts for first 3 days)
  • Severe dry cough (lasts for first 3 days)
  • Chest discomfort
  • Gastrointestinal Symptoms (present in 30% of children, uncommon in adults) Nausea or Vomiting
  • Abdominal Pain
  • Other symptoms include Anorexia (may persist for first week)
  • Fatigue persists weeks
  • Severe Malaise (may persist for more than a week)
  • Dizziness

When To Use Telemedicine For The Flu:

If you have these symptoms above you should immediately use telemedicine to obtain such antivirals as Tamiflu. Tamiflu is most effective within 48 hours of the onset of the above symptoms.  

The symptoms peaks with illness severity and declines over 4-5 days.  The acute symptoms can resolve in 4-5 days however, persistent symptoms such as fatigue, malaise, and a non-productive cough for 3 or more weeks.  Cough medication such as promethazine DM and tessalon perles are often prescribed along with Tamiflu.  

Labs and Radiology To Diagnose The Flu:

Labs and radiology are uncommon however if prompted, our providers can order a Complete Blood Count and Chest X-Ray if needed.  

Should I Get A Flu Swab?

The classic triad of Fever, Cough, and Pharyngitis are specific for influenza in > 75% in adults and >60% in children.  Thus, sitting in a waiting room all day to obtain a flu swab can be wasteful and counterproductive to getting better by resting at home.  Rapid Influenza Testing has a poor test sensitivity < 50% and does not exclude influenza if it is negative.  

When To Go To The Emergency Room For Influenza:

If you are experiencing any of the following you should seek a Emergency Room:

  • Dull left sided chest pain
  • Altered level of consciousness
  • Seizures
  • Severe Weakness
  • Hemoptysis (blood in coughing)
  • Cyanosis (blue colored skin), labored breathing or shortness of breath
  • Decreased Urine Output

Who Is High Risk For Complications Of The Flu:

  • Children under age 2 years old
  • Elderly (over 65 years old)
  • Chronic medical conditions (COPD, Asthma)
  • Immunosuppressed patients
  • Obese patients with BMI >40
  • Alaskan natives and native americans
  • Pregnancy

When To Go To Your Primary Doctor For Influenza:

DOC in a box always recommends the client to follow up with their PCP after any visit.  However, you should see a primary care doctor if your cough or any other symptoms persist past 3 weeks.  

DOC in a box Treatment Plan For Influenza:

If you have been prescribed a Medrol Dose Pack, please take it with OTC Zantac or Prilosec until the medication is finished. Please allow 2-3 days for the symptoms to improve. Increase fluids and rest. Alternate tylenol and motrin until the fever has resolved. If given cough medications please read the directions on the packaging.  Tessalon Perles are to be used during the daytime as they do not cause insomnia.  Promethazine DM should only be used at night time due to its sedative effects.  If you are given Tamiflu please read the side effects in the packaging.  Taking Zinc and Vitamin C will also decrease the symptoms of the flu. 

If the symptoms have persist beyond our normal treatment you will need to see a provider again to adjust any medications and for any refills.

Can I Get A Zpack For This?

It is very rare that a bacterial infection will occur if you have the flu.  Therefore a Zpack will only cause your normal bacterial flora to become resistant to antibiotics.  Taking antibiotics for Non-Bacterial infections can cause problems such as C-Diff, Diarrhea, Loss of Taste and Loss of GI flora.  The symptoms of cough, congestion, fatigue, and sore throat are common with viral infections and will go away through out time.  Therefore, if a provider has denied this medication, it is to protect you from doing any more harm to your body.  

But This Cough Though?

It is common to have a cough up to 4 weeks post viral infection.  Over the counter medications can help along with any prescription medications. DOC in a box does not prescribe promethazine with codeine or Robitussin with codeine.  If you smoke, stop smoking, if you vap, stop vaping.  If the cough last longer than 4 weeks we recommend following up with your PCP.  

Everyone In My Office Has The Flu, Can I Get Tamiflu?

It is not common practice to prophylactic with Tamiflu when you have no symptoms.  Taking Tamiflu without a viral infection can also lead into viral resistance.  

Topics: Treatment Plans, Influenza

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