Recent NIH COVID-19 guideline updates include evidence-based considerations for treatment of patients hospitalized with flu and COVID-19 coinfection.
The National Institutes of Health on in late October 2020made updatesto its COVID-19 Treatment Guidelines that provide treatment considerations for patient hospitalized with either suspected or confirmed SARS-CoV-2 and influenza coinfection. Click through the short slide show for guidance.
Corticosteroids, which may be used for the treatment of COVID-19, may prolong influenza viral replication and viral RNA detection and may be associated with poor outcomes.
Oseltamivir has no activity against SARS-CoV-2. Oseltamivir does not have any known interactions with remdesivir. Standard-dose oseltamivir is well absorbed even in critically ill patients. For patients who cannot tolerate oral or enterically administered oseltamivir (eg, because of gastric stasis, malabsorption, or GI bleeding), intravenous peramivir is an option. There are no data on peramivir activity against SARS-CoV-2.
CDC does not recommend inhaled zanamivir and oral baloxavir for the treatment of influenza in hospitalized patients because of insufficient safety and efficacy data (see the CDC Influenza Antiviral Medications: Summary for Clinicians). There are no data on zanamivir activity against SARS-CoV-2. Baloxavir has no activity against SARS-CoV-2.
Based upon limited data, the co-occurrence of community-acquired secondary bacterial pneumonia with COVID-19 appears to be infrequent and may be more common with influenza. Typical bacterial causes of community-acquired pneumonia with severe influenza are Staphylococcus aureus (methicillin-resistant S. aureus [MRSA] and methicillin-susceptible S. aureus [MSSA]), Streptococcus pneumoniae, and group A Streptococcus.
Patients with COVID-19 who develop new respiratory symptoms with or without fever or respiratory distress, and without a clear diagnosis, should be evaluated for the possibility of nosocomial influenza.