INFLUENZA IN SERIOUSLY ILL

Accumulating evidence supports the use of specific diagnostic tests and antiviral therapies for seriously ill patients with influenza. Among available diagnostic tests, reverse-transcriptase polymerase chain reaction is faster than culture and more sensitive than commercial antigen assays. Current neuraminidase inhibitors were approved on the basis of their efficacy in ambulatory patients, but seriously ill patients who receive these agents are less likely to die, even when treatment is initiated 148 h after symptom onset. For patients hos-pitalized with suspected influenza, it is unclear which circumstances warrant diagnostic testing and which warrant the use of empirical therapy. Rapid antigen assays may reduce the unnecessary use of other tests and medications but are relatively insensitive, thus eliminating many patients with influenza as candidates for treatment. Empirical antiviral therapy ensures that all patients receive treatment promptly, at a cost equivalent to that of diagnostic tests alone, but results in the receipt of treatment by many patients without influenza. For patients hospitalized with suspected influenza, clinicians need to combine these approaches in order to optimize patient care. Current management guidelines for influenza typically emphasize the prevention and treatment of uncompli-cated seasonal disease [1]. Nevertheless, even vaccinated patients may become seriously ill from influenza virus infection, and evidence to guide clinical care decisions for these patients is sparse. Data compiled from several recent studies suggest that the time has come to re-consider the approach to influenza treatment for pa-tients who require hospitalization. Two questions must be answered: (1) is there a benefit to antiviral treatment of influenza in seriously ill patients, and (2) how should influenza be diagnosed in hospitalized patients