A 53-year-old woman comes to the office due to 3 days of fever, headaches, severe myalgias, and weakness. She has had dry cough but no wheezing, shortness of breath, or chest pain. The patient's sister recently had similar symptoms. The patient received the influenza vaccine a week ago. She has no other medical problems and takes no medications except over-the-counter supplemental vitamins. The patient does not use tobacco, alcohol, or illicit drugs. She is not allergic to any medications. Temperature is 38.2 C (100.8 F), blood pressure is 133/78 mm Hg, pulse is 101/min, and respirations are 14/min. BMI is 30 kg/m². The patient appears flushed but in no distress. The oropharynx is hyperemic with no exudates. Mild cervical lymphadenopathy is present. Cardiopulmonary examination reveals no abnormalities. The abdomen is soft with no organomegaly. Throat swab for influenza A viral antigen is positive. Which of the following is the most appropriate next step in management of this patient?

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Explanation: 11ec2b69_bfa7_85ed_8f63_69dbea95d084_MD0005_00 This middle-aged patient with a sick contact and 3 days of fever, headache, myalgias, and weakness has positive testing for influenza. Influenza can be treated with antiviral medication (eg, oseltamivir) to reduce symptom duration and, potentially, the risk of developing influenza-related complications (eg, secondary pneumonia). However, antiviral efficacy declines precipitously when initiated >48 hours after symptom onset. Therefore, the Centers for Disease Control and Prevention recommends that healthy patients with >48 hours of symptoms receive symptomatic care (eg, acetaminophen) alone. Patients with <48 hours of influenza symptoms should receive antiviral therapy. In addition, patients who require hospitalization, have severe or progressive illness, or are at high risk (eg, age >65, immunocompromised) of influenza-related complications should be treated with antivirals regardless of symptom duration. Although influenza vaccination is an important preventive modality, vaccination does not guarantee immunity to active influenza strains, and full preventative effects (humoral antibody response) may take >2 weeks to develop. (Choices A, B, and D) This patient has influenza; azithromycin, a bacterial antibiotic, would not be effective. In addition, because symptoms have been present >48 hours and she has no high-risk conditions, this patient is not a candidate for oseltamivir. (Choice E) High levels of resistance have emerged against the adamantane (eg, rimantadine) medications; this class of medication should generally be avoided for the treatment of influenza in the United States. Educational objective: Influenza treatment with antiviral medications (eg, oseltamivir) is recommended for patients who require hospitalization, have severe or progressive illness, or have underlying high-risk medical conditions. Oseltamivir is also recommended for low-risk patients with mild disease who present <48 hours after symptom onset. Previously healthy patients with >48 hours of symptoms should receive symptomatic care (eg, acetaminophen) alone.

A 53-Year-Old Woman Comes to the Office Due to 3