Severe Influenza Checklist



Diagnostic tests 

 - Blood cultures x2 

 - Sputum gram stain & culture 

 - Urine legionella & pneumococcal antigens 

 - Nares PCR for MRSA 

 - Procalcitonin 

 - Ferritin, liver function tests 

 - Ultrasound if needed to exclude effusion 

 - CT scan if diagnostic uncertainty (e.g. vs PE or opportunistic infection). 

Resuscitation & respiratory support 

 - Fluid conservative resuscitation — DO NOT bolus 30 cc/kg fluid. 

 - Consider early high-flow nasal cannula for dyspnea/tachypnea. 

Antibiotics

 - Oseltamavir 75 mg BID (or IV peramivir if NPO) 

 - Clarithromycin 500 mg BID (azithromycin if clarithromycin unavailable or fiQT) 

 - Beta-lactam until bacterial pneumonia excluded (ceftriaxone, piptazo, or cefepime) 

 - Linezolid 600 mg PO/IV q 1 2hr if post-flu MRSÅ pneumonia suspected 

Adiunctive treatments 

 - Steroid only if other indication (e.g. COPD/asthma or adrenal insufficiency). 

 - May consider ascorbic acid 1.5 grams IV q6hr & thiamine 200 mg IV ql 2hr 

 - May consider naproxen —200 mg BID if <96hr of symptoms, lab-confirmed influenza, pulmonary infiltrates, and GFR > 30 ml/min without AKI 



Dr. Josh Farkas @PulmCrit



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