Influenza in Urgent Care (Pharmacology CME)

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Delivery Method:	Online
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Publication Date: December 2022 (Volume 1, Number 9)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 12/01/2025.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 2 Pharmacology CME credits, subject to your state and institutional requirements.

Editor-in-Chief

Urgent Care Update Author

Peer Reviewers

Charting & Coding Author

Abstract

Urgent care clinicians should be aware of the most current diagnostic and therapeutic recommendations for influenza and the resources available for guiding management. This review outlines the classification of these viruses, their pathophysiology, the identification of high-risk patients, and the importance of influenza vaccination. Seasonal variations of influenza are discussed, as well as the considerations regarding which patients to test based on the current local prevalence of disease. Given the significant overlap in clinical presentations, co-evaluation for COVID-19 is also briefly discussed in the context of the evaluation and management of influenza. Differences between strains of influenza are reviewed. Recommendations for use of the currently available antiviral treatments are discussed, as well as how to engage in shared decision-making with patients regarding risks and benefits of testing and treatment.

Case Presentations

A 20-month-old boy presents to the urgent care center with a cough and fever for 2 days...

• He has no past medical history, and his routine vaccinations are up to date. A COVID-19 rapid antigen test administered at home was negative.
• His parents say he has been eating less than usual; however, his urine output is normal, and he has had no vomiting or diarrhea.
• Vital signs are: temperature, 39.6˚C (103.2°F); heart rate, 156 beats/min; respiratory rate, 32 breaths/ min; and oxygen saturation, 100% on room air.
• He is well-appearing, although his left tympanic membrane is erythematous and bulging, with apparent middle-ear purulence.
• You make the diagnosis of otitis media in the setting of a presumed viral upper respiratory infection. While preparing the discharge papers, you consider whether testing or treating for influenza would also be appropriate…

A 34-year-old man presents with cough and fever that started 3 days before…

• His maximum temperature at home was 40˚C (103.9°F). He has been taking over-the-counter cold remedies without much relief and feels fatigued and “achy all over.”
• He has no regular primary care provider and has no significant past medical history.
• His initial vital signs are: temperature, 38.2˚C (102.5°F); heart rate, 108 beats/min; respiratory rate, 20 breaths/min; blood pressure, 134/78 mm Hg; and oxygen saturation, 96% on room air.
• On examination, he appears uncomfortable and has some tachypnea. The oropharynx is clear and the neck supple. His lungs are clear without any wheezing. The abdomen is soft and nontender.
• His rapid COVID-19 test returns negative and a chest x-ray reveals no infiltrates.
• You wonder whether you should also test for influenza, and if so, what type of test, and how reliable would it be? If you test and it’s positive, should you empirically prescribe an antiviral medication or just recommend supportive care?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.