Summary: Seek medical care immediately if you have significant underlying medical problems (see list below of high risk conditions) and you develop a flu-like illness (i.e., fever PLUS cough or sore throat) at a time when flu is actively circulating in your community. All people with flu symptoms should seek medical care if they develop breathing difficulty, inability to drink fluids, or if their fever extends more than five days. Most otherwise healthy people with flu-like illness will recover fully with symptomatic care at home and will need no special medications or interventions from a doctor if they are improving within 4-5 days of the start of the illness.
Influenza can cause severe symptoms, and a small proportion of infected people may die from flu. At least 90% of deaths due to influenza in the USA are in people over age 65 years; death in young, healthy people is uncommon.
Most otherwise healthy people with flu recover fully from their infection without any special medications or interventions from a doctor. Here are several key points to be aware of to help you to decide when you should seek care for yourself or a family member.
Antiviral Medications for Flu There are several antiviral medications available for flu, but they are only marginally helpful in most people. Studies have shown that antiviral medications can shorten the duration of flu by 12-36 hours if taken within 48 hours of the first symptom. This means that for most people, the illness can be shortened to four or five days with antiviral medications compared to five or six days without them.
There have been a handful of studies demonstrating that these medications can save lives, but those studies were conducted in hospitalized older adults with significant underlying health problems. There are no randomized, controlled studies showing that outpatient treatment of young, healthy people under age 50 reduces the death rate due to flu, in part because the death rate in this age group is quite low already.
There was some weak evidence for lower mortality in hospitalized young adults who were treated for influenza due to the pandemic strain in 2009-2010. Patients who are ill enough to be hospitalized for an influenza infection generally are treated with antiviral medications, even if their symptoms have been present for more than 48 hours.
Who should get antiviral medications for flu? The current recommendation from the CDC is to use antiviral medications for outpatients with flu symptoms if the patient is in a group that is known to be at increased risk for complications. Treatment should be started within the first 48 hours of the onset of the illness; if treatment is delayed past 48 hours, there is little to no benefit. These high risk groups include:
Patients over age 65 years
Patients under age 2 years
Pregnant females
Obese persons with a BMI greater than 40
Immunocompromised persons
People housed in a chronic care facility
Chronic medical problems including; pulmonary, including asthma or COPD; cardiac (excluding hypertension); liver failure; renal failure, especially on dialysis; neuromuscular disorders that impair ventilation
Click here for detailed information from CDC about who should be treated for flu. People in high risk groups should see their doctor immediately if they develop fever PLUS either cough or sore throat during the flu season.
Antibiotics and Flu It is critical to note that antibiotics are completely useless against the influenza virus, since antibiotics kill bacteria, not viruses. Antibiotics may be helpful if complications such as middle ear infection or pneumonia develop during the course of the flu.
So when should the average person with flu see a doctor? In general, use of antiviral medications for otherwise healthy people who have acute symptoms of flu is not necessary, so medical evaluation is also not necessary for these people. Many people who have a flu-like illness do not have flu at all, but instead are infected by another respiratory virus that mimics flu. Flu antiviral medications are not helpful for any of these other viruses. For otherwise healthy people, treatment of a flu-like illness primarily consists of: bed rest; lots of fluids; medications for fever and pain such as acetaminophen or ibuprofen; and time. Well over 99% will recover fully.
The fever from flu typically lasts up to five days, and the cough may continue for a week or longer. People should seek medical care if fever persists longer than five days, if symptoms are worsening after 48-72 hours of illness, if breathing difficulty develops, or if they are unable to drink fluids.
Jim Wilde MD, FAAP
Professor of Emergency Medicine and Pediatrics
Augusta University, Augusta Georgia