Influenza-related pneumonia

Editor – In regard to the CME Respiratory Medicine article by Almond et al on influenza-related pneumonia (Clin Med February 2012 pp 67–70), I would like to correct a point on when to administer antiviral therapy.

It is stated in the article that based on Department of Health recommendations¹ uncomplicated influenza infection should be treated with prompt commencement of antiviral therapy. However, more recent guidelines from the Health Protection Agency² state that generally in an uncomplicated presentation of influenza, treatment, other than symptomatic, is not required.

While it is correct that in the hospital setting all patients with influenza should be given antiviral drugs such as oseltamivir, in the community those patients with an uncomplicated presentation should only receive antiviral treatment if they have underlying health issues such as chronic heart, liver, pulmonary or renal disease.

Oseltamivir does have potential significant side effects such as nausea, vomiting and abdominal pain, and even reports of more serious adverse effects such as hepatitis, neuropsychiatric disorders and Stevens–Johnson syndrome,³ and so the risk-benefit balance in uncomplicated cases in the community favours not giving it.

• © 2012 Royal College of Physicians