Has anyone had success with the QuickVue influenza test kits? Should patients with flulike symptoms be treated with antibiotics regardless of test results?—BEN SCHAEFER, PA-C, Rockford, Mich.

The QuickVue test can detect influenza A and influenza B and is reported to have a sensitivity of 73%-81% with a specificity of 95%-99%. There will be very few false positives. Treatment with an antiviral such as oseltamivir (Tamiflu) is appropriate if a patient’s symptoms and signs are consistent with influenza, the rapid test is positive, and symptoms started within the 48 hours preceding the examination. Antibiotics are not indicated unless there is evidence of a secondary bacterial infection, such as pneumonia. If the test results are negative, consider other diagnoses (e.g., common cold, sinusitis, pneumonia, and meningitis). Such a result could also be a false negative. I would be reluctant to prescribe antibiotics unless I thought the patient had pneumonia (a chest x-ray can confirm this diagnosis), meningitis (lumbar puncture and hospitalization indicated), or a significant sinusitis that required treatment. Influenza is usually a clinical diagnosis based on typical symptoms and an increased number of cases in the community. A healthy person with influenza—which, of course, is a viral infection—will usually recover in a few days simply by resting and drinking clear fluids.—JoAnn Deasy, PA-C, MPH (147-2)

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