Infectious Diseases I
This patient likely has severe influenza amid a local
seasonal outbreak. Local infection patterns suggest
a prevalence of influenza A and B strains. Empiric
influenza-specific
therapy
against
these
strains
should be initiated in patients with severe influenza
before confirmatory test results are known to avoid a
delay in appropriate therapy (Answer B is incorrect).
Neuraminidase-based therapy is recommended for
modern influenza A and B stains (Answer D is correct;
Answer C is incorrect). Even if they are outside 48 hours
from symptom onset, patients with severe influenza
have benefited from therapy initiated beyond this period
(Answer A is incorrect).
Neuraminidase inhibitors are the mainstay of treat-
ment because resistance to adamantanes has developed
in contemporary influenza A strains, and these agents
have no antiviral activity against influenza B (Answer
A is incorrect). Inhaled zanamivir is not appropriate
for administration to mechanically ventilated patients
(Answer C is incorrect). Intravenous peramivir also is
available; however, data are limited for its use in criti-
cally ill patients with severe, complicated influenza
infection (Answer D is incorrect). Enteral oseltamivir
is the preferred therapy for current influenza B strains
in critically ill patients with severe, complicated influ-
enza infection (Answer B is correct). Clinicians should
be mindful of the need for renal dosage adjustment, if
necessary.
Remdesivir is recommended for patients requiring
supplemental oxygen. On the basis of the results of the
ACTT study showing no difference in recovery time or
mortality in more severe subgroups, the NIH guidelines
do not recommend for or against remdesivir in patients
requiring high-flow oxygen, MV, or ECMO (Answer D
is correct; Answers A and C are incorrect). If remdesivir
is initiated before advancing to MV, it is recommended
to continue and complete therapy. Available evidence
guidelines do not suggest increased adverse effects with
remdesivir between less and more severely ill patients
(Answer B is incorrect).