The role of antiviral therapy for individual benefit in patients with influenza

Antiviral therapy has a limited role in the management of influenza for individual benefit; it is only recommended for select patient groups.

When started within 48 hours of symptom onset in otherwise healthy adults who have a low risk of complications, antiviral therapy reduces duration of influenza symptoms by approximately 1 day. Such limited benefit must be balanced against the potential adverse effects of antiviral therapy, including nausea, vomiting, headaches and neuropsychiatric eventsJefferson, 2014.

Use antiviral therapy for patients with influenza who are:

admitted to hospital for management. The benefit is greatest when treatment is started within 48 hours of illness onset, but should still be considered up to 7 days after symptom onsetAdlhoch, 2023 Katzen, 2019 Muthuri, 2014 Walsh, 2022
pregnant or up to 2 weeks postpartumChow, 2021 Uyeki, 2018.

Consider antiviral therapy for other people at higher risk of severe illness or complications of influenza – see People at higher risk of severe illness or complications of influenza.

For advice on prevention of influenza, including antiviral regimens, see Antiviral therapy for patients with influenza to prevent transmission, Postexposure antiviral prophylaxis for influenza and Vaccination to prevent influenza.

For detailed recommendations about management of influenza and avian influenza, see the Communicable Diseases Network Australia (CDNA) guidelines on influenza.

Figure 1. People at higher risk of severe illness or complications of influenza. [NB1]Uyeki, 2018

adults aged 65 years and olderWorld Health Organization (WHO), 2024
people who are pregnant or up to 2 weeks postpartumChow, 2021
children younger than 5 years, particularly younger than 2 years and preterm (less than 37 weeks gestation)Malosh, 2018
Aboriginal and Torres Strait islander people of any age [NB2]Li-Kim-Moy, 2016
residents of an aged-care facility or long-term residential facility
people with any of the following conditionsWorld Health Organization (WHO), 2024:
- immune compromise (eg HIV, cancer, asplenia, haematopoietic stem cell or solid organ transplant recipients, systemic corticosteroids)
- cardiovascular disease
- a neurological or neurodevelopmental disorder (eg Down syndrome)
- chronic lung disease (eg asthma, COPD, cystic fibrosis)
- chronic kidney disease
- a chronic metabolic or endocrine disorder (eg diabetes).

Note: COPD = chronic obstructive pulmonary disease; HIV = human immunodeficiency disease

Note: NB1: Antiviral therapy is recommended for people with influenza who are admitted to hospital for management and those who are pregnant or up to 2 weeks postpartum. Antiviral therapy can be considered for the other people listed in this figure.

Note: NB2: Health outcomes are significantly impacted by geographical, historical, socioeconomic, spiritual, emotional and cultural determinants. In Aboriginal and Torres Strait Islander peoples, the incidence of infection and increased risk of poor health outcomes can be linked to complex socioeconomic factors, including poverty, reduced access to health services, incarceration, discrimination and intergenerational trauma. A shared strengths–based approach to healthcare that recognises each patient's unique cultural determinants and circumstances is essential.