We encounter children with respiratory infections of varying severity on a daily basis. Around 5% of them present with continuous high grade fever, cough and malaise( for upto 5 days) which had not responded to antibiotics like Amoxycillin, Cephalosporins or Azithromycin. In this minor subset, we usually start Oseltamivir, and have seen dramatic resolution of symptoms within 24 hours. Testing for influenza is almost always not possible in our setting. So are we justified in this line of management?
I'd not advice Oseltamivir use on such patients because natural history of this( could be non-flu virus) viral illness has made the difference. perhaps more parent will start requesting it and this may lead to over use and chance of antiviral resistance.
I appreciate the point, the important aspect to note is that the relatively low number of patients who do fall into the minor subset, maybe one or two in a month, and the drug is administered in the hospital. We usually reserve the drug only for the most serious cases and not all non responders.
I think you are better off getting rapid tests for influenza A and B at your site. Really, they are extremely economical, and very reassuring. It's unwise to initiate oseltamivir after a course of antibacterial agents (such as amoxicillin) because the therapeutic effect of oseltamivir is greatest early in the course of the disease, ideally in the first 2-3 days of symptoms. In contrast to the rapid tests, a course of oseltamivir is expensive, as is a course of azithromycin. Parents really appreciate a rapid test diagnosis that confirms or rules out on their first visit influenza.
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