treat pregnant patient with oseltamivir empirically

The Centers for Disease Control recommend prompt initiation of empiric treatment of influenza (ie, within 48 hours of illness onset) in women who are pregnant or postpartum and have flu symptoms because they are at particularly increased risk of serious complications. The neuraminidase inhibitors oseltamavir and zanamivir are considered safe and effective in pregnancy; oseltamavir is preferred because more data are available to assess the risks and benefits (choice C is correct; choice D is incorrect).

While influenza vaccines are recommended for all pregnant women, they reduce the risk of infection by only around 50%. Therefore, the assumption that this patient’s symptoms are not caused by influenza because she was vaccinated is incorrect, and treatment should be started promptly regardless of vaccination status (choice A is incorrect). While a rapid influenza diagnostic test (RIDT) yields a result in around 15 min and is highly specific for the diagnosis, these tests are only 50% to 70% sensitive and more likely to yield false negatives when flu is more prevalent in the community. Therefore, this patient should be treated regardless of the result of the RIDT (choice B is incorrect).