Influenza

Also known as: flu · oseltamivir

Also relevant to Respiratory

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United StatesIDSA/CDC

Current

Clinical Practice Guideline Update for the Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza

Infectious Diseases Society of America (IDSA) · 2018 · 2018 update

The IDSA guideline addresses diagnostic testing, antiviral treatment, chemoprophylaxis and institutional outbreak control for seasonal influenza, updating the society's 2009 document.

It covers special populations including children, pregnant patients and severely immunocompromised patients. source
The document explicitly excludes influenza vaccination recommendations, non-healthcare outbreaks and novel animal-origin influenza viruses. source

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EuropeESCMID/ECDC

CurrentGlobal guideline

Clinical practice guidelines for influenza

World Health Organization (WHO) · 2024

WHO's guideline on the clinical management of suspected or confirmed influenza, spanning severe and non-severe illness and post-exposure antiviral prophylaxis, for use across all levels of the health system.

It is an update and expansion of WHO's earlier guideline on managing patients with severe influenza or at risk of severe influenza. source
The scope was broadened to include antiviral treatment of non-severe influenza and post-exposure chemoprophylaxis, using GRADE methodology. source

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US vs EU key differences

Version currency differs sharply: the US IDSA guideline dates to 2018, while WHO issued a new clinical practice guideline for influenza in 2024. source
WHO 2024 makes a strong recommendation against oseltamivir (and zanamivir and favipiravir) in non-severe influenza without risk factors, a more restrictive stance than the 2018 IDSA guideline, which allows antiviral treatment to be considered in that group. source
Drug ordering differs for high-risk outpatients: WHO 2024 conditionally recommends baloxavir for non-severe influenza at high risk of progression, whereas the 2018 IDSA guideline is built around neuraminidase inhibitors, principally oseltamivir. source
The two converge on adjunctive therapy: WHO 2024 conditionally recommends against corticosteroids in severe influenza, and IDSA 2018 likewise advises against routine adjunctive corticosteroids. source

What changed recently

GLOBAL2022 → 20242024-09-13
The 2024 WHO update extended scope from severe influenza to non-severe disease and added recommendations on baloxavir marboxil, favipiravir and umifenovir. It advises against oseltamivir in non-severe influenza, conditionally supports early baloxavir only for non-severe patients at high risk of progression, and keeps oseltamivir as a conditional option for severe influenza.
source ↗curation confidence 90%
US2009 → 2018 update2018-12-19
The 2018 IDSA update was the first revision since before the 2009 H1N1 pandemic. It moved diagnosis toward rapid molecular assays instead of antigen-based rapid tests, incorporated peramivir as a parenteral antiviral option, broadened the recognised risk factors for severe disease, and clarified that antiviral treatment is optional rather than automatic for low-risk outpatients presenting within two days of onset.
source ↗

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