Treatment of influenza in the community

Influenza is typically a self-limiting viral illness in healthy individuals, managed primarily with supportive self-care, symptom relief, and hygiene measures (1):

• antiviral treatment with oseltamivir or zanamivir is recommended during circulating influenza seasons for individuals in clinical at-risk groups or those with severe immunosuppression presenting with acute non-severe disease (see linked items for detailed guidance on antiviral treatment and post-exposure prophylaxis) (2, 3)
• clinical assessment should focus on identifying signs of severe illness or secondary complications that require urgent hospital admission or targeted therapeutic management (1, 3)

General Advice and Symptomatic Relief

Conservative Management Strategies

• advise rest, adequate hydration, and avoidance of active or passive exposure to tobacco smoke (1)
• advise patients to remain at home while symptomatic to reduce transmission, avoiding close contact with vulnerable or immunocompromised individuals (1, 3)
• consider short courses of over-the-counter topical nasal decongestants, throat lozenges, or saline nasal rinses for localized upper respiratory symptom relief (1)

Antipyretic and Analgesic Therapy

• recommend paracetamol or ibuprofen for the management of fever, headache, and generalized myalgia (1)
• contraindication: aspirin must not be administered to children or young people under 16 years of age due to the risk of Reye's syndrome (1)

Antiviral Therapy and Complications Management

Antiviral Prescribing in Risk Groups

• prescribing of antivirals (oseltamivir or zanamivir) in primary care is permitted under General Medical Services (GMS) regulations once circulating influenza is confirmed by national surveillance (see linked items for full clinical risk group criteria and dosing regimens) (2, 3)
• updated UK Health Security Agency (UKHSA) guidance uses international WHO/ECDC terminology ("severe / non-severe" influenza) to frame primary care management and triage (3)

Secondary Bacterial Infections and Complications

• complications of influenza include secondary bacterial pneumonia, acute otitis media, tracheobronchitis, and exacerbations of chronic respiratory or cardiovascular disease (1, 3)
• administer empirical antibiotic therapy promptly if secondary bacterial pneumonia or severe clinical deterioration occurs (1)

Reference:

1. British Infection Association (BIA), British Thoracic Society (BTS), Health Protection Agency (HPA). Pandemic flu: clinical management of patients with an influenza-like illness during an influenza pandemic. Thorax. 2007;62 Suppl 1:1-46.
2. National Institute for Health and Care Excellence (NICE). Amantadine, oseltamivir and zanamivir for the treatment of influenza. NICE Technology Appraisal [TA168]. 2009.
3. UK Health Security Agency (UKHSA). Guidance on use of antiviral agents for the treatment and prophylaxis of seasonal influenza. UKHSA Public Health Guidance. Updated October 2026.