Influenza: Do you care, and do you require this....

[GetMeOuttaThisMess]

Tis' the season.  First, do you do rapid flu tests (aside from revenue generation) considering that most can't or won't pay the cost for the equivocal benefit of Tamiflu?  Second, do you continue to consider the diagnosis in the absence of fever?  Influenza-like illness per CDC criteria requires fever (>100.5) with odynophagia and/or cough.  CDC leads one to believe that it's as common as seeing a chupacabra in south Texas.

 

Had one in office today that another provider tested which was quickly positive for "A" strain.  That being said, in absence of widespread disease the false-positive rate is not insignificant.  What I'm seeing is 3+ weeks duration of snot (with some really gnarly TMs), odynophagia, and lingering cough (predominantly the cough).  I fail to understand why we consider the eustachian tubes our friends when they are a royal pain in our bums when they are occluded and can't drain the middle ear.

 

Personally, if you don't have a fever when I see you (regardless of the fact that "It was 103 degrees 30" ago at home") and you don't look like death warmed over, you aren't getting the magical diagnosis from me.

 

Third question, would you rather have what's behind door number one which is three weeks of moderate severity crap primarily consisting of cough, or what's behind door number two which is 5-7 days of "I want to die" influenza knowing you won't have a pneumonia complication?

 

One thing that I'm doing on everyone is giving a three day course of 20 mg. b.i.d. prednisone for either sinus inflammation, pharyngeal inflammation, or bronchial inflammation.  Wish I'd had access to it over Turkey Day weekend.

 

Happy Snotty Days to All, and to All a Crappy Night (hack hack)!

[ohiovolffemtp]

Yes, I do rapid flu swabs.  Patients want a diagnosis.  Having a supportive lab is helpful.  It helps with the antibiotics won't help you speech.  I don't prescribe Tamiflu.

[BruceBanner]

We dont do rapid flu because of poor sensitivity. Tamiflu only if within 48 hours of sx onset and if confirmed close contact with flu..personally I dont write it anymore.

 

I will give sometimes give 1-2 days of PO Decadron for severe pharyngeal inflammation, but not that liberally for typical URI junk. Prednisone is only for the asthmatics and COPDers. 

[EMEDPA]

I give Tamiflu to very few pts; old, immunocompromised, little kids, pregnant, etc. probably 2-3 rxs/yr.

[Guest JMPA]

Tis' the season.  First, do you do rapid flu tests (aside from revenue generation) considering that most can't or won't pay the cost for the equivocal benefit of Tamiflu?  Second, do you continue to consider the diagnosis in the absence of fever?  Influenza-like illness per CDC criteria requires fever (>100.5) with odynophagia and/or cough.  CDC leads one to believe that it's as common as seeing a chupacabra in south Texas.

 

Had one in office today that another provider tested which was quickly positive for "A" strain.  That being said, in absence of widespread disease the false-positive rate is not insignificant.  What I'm seeing is 3+ weeks duration of snot (with some really gnarly TMs), odynophagia, and lingering cough (predominantly the cough).  I fail to understand why we consider the eustachian tubes our friends when they are a royal pain in our bums when they are occluded and can't drain the middle ear.

 

Personally, if you don't have a fever when I see you (regardless of the fact that "It was 103 degrees 30" ago at home") and you don't look like death warmed over, you aren't getting the magical diagnosis from me.

 

Third question, would you rather have what's behind door number one which is three weeks of moderate severity crap primarily consisting of cough, or what's behind door number two which is 5-7 days of "I want to die" influenza knowing you won't have a pneumonia complication?

 

One thing that I'm doing on everyone is giving a three day course of 20 mg. b.i.d. prednisone for either sinus inflammation, pharyngeal inflammation, or bronchial inflammation.  Wish I'd had access to it over Turkey Day weekend.

 

Happy Snotty Days to All, and to All a Crappy Night (hack hack)!

2 recommendations: , i would not be prescribing steroids so liberally (its malpractice) and i do not consider it fever unless >100.8

[GetMeOuttaThisMess]

2 recommendations: , i would not be prescribing steroids so liberally (its malpractice) and i do not consider it fever unless >100.8

So what do you give your straight forward pharyngitis/tonsillitis where studies show short course, low dose steroids are most helpful for pain relief? These dosing schedules certainly have less systemic impact than a single dexamethasone injection which stays in system > 1 week. I'm less a fan of viscous lidocaine after seeing a woman who cannibalized her lower lip a couple of decades back.

 

Had a fellow PA many years back who moonlighted in a community for-pay clinic. EVERYONE she said got a shot of Rocephin and steroid regardless of presenting complaint. THAT scenario I would not want to defend. You give asthmatic bronchitis patients short course steroids, croup steroids, and rhinitis/sinusitis patients nasal steroids so one can kill three birds with one stone in these scenarios.

[EMEDPA]

I usually use single dose PO decadron for the scenarios you described above, especially in kids.

[True Anomaly]

My first year of practicing was during the swine flu hysteria, and it was a great time to learn how to differentiate the influenza evaluation.  So I only do the swab if they're very likely to be admitted (think sepsis criteria), or within that magic 48 hour window WHILE ALSO having immunocompromised risk factors and/or asthma history.

[Marinejiujitsu]

My first year of practicing was during the swine flu hysteria, and it was a great time to learn how to differentiate the influenza evaluation. So I only do the swab if they're very likely to be admitted (think sepsis criteria), or within that magic 48 hour window WHILE ALSO having immunocompromised risk factors and/or asthma history.

Winner.

 

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[GetMeOuttaThisMess]

Winner.

 

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I think the CDC would agree with you.

[EMEDPA]

just gave out my first tamiflu of the season. 80ish yr old lady with multiple issues with 24 hrs of sx. truly miserable. almost admitted her, but she wanted to try going home.

[GetMeOuttaThisMess]

just gave out my first tamiflu of the season. 80ish yr old lady with multiple issues with 24 hrs of sx. truly miserable. almost admitted her, but she wanted to try going home.

 

 

Immunized, and if so, traditional dosing or "high dose"?

[EMEDPA]

she was immunized. don't know which regimen. influenza A +

[GetMeOuttaThisMess]

Okie dokie

[cbrsmurf]

2 recommendations: , i would not be prescribing steroids so liberally (its malpractice) and i do not consider it fever unless >100.8

 

Explain the first half, please

[ventana]

I work in a jail

 

we swab everyone going forward with a fever - to figure out when flu hits us - then stop once it is endemic

 

Via CDC guidelines we offer tamiflu 

I would never take the stuff - just work it out.....

 

But them be the choices we make

[probasestealer]

Nobody has mentioned Tamiflu prophylaxis for spouse, kids, etc..

 

I usually swab all patients who have "flu" symptoms and if positive discuss the options risks/benefits of Tamiflu.

[Marinejiujitsu]

I always here about tamiflu shortages. Therefore, I save it for the immunocompromized.

 

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[Moe 103]

I use the flu test and prescribe Tamiflu. Working in a busy peds practice we are very sensitive to patients living with high-risk groups. My experience has been that those treated within the first 12 hours of onset respond very well to Tamiflu. We counsel our parents that if they have one positive case in the house to call us immediately if another family member develops a fever >101. Expectant mothers or those with infants under 9 months, or if they have family members in the high-risk group we recommend prophylactic treatment. I work in a densely populated urban environment, so my ROE might differ from other posters.