Q: My 20 years old friend had fever and dry cough a month ago. He was admitted to the hospital and was given high doses of antibiotics like Amikacin and Meropenem for high fever (105 F) and cough. But his condition deteriorated with a TLC of 29,900/cu mm and pus cells in urine were about 50. His throat swab tested positive for H1N1. Treatment with Tamiflu was started along with some antibiotics. His condition began to improve and after 5 days of treatment, his TLC came down to 11,000, no pus cells in urine and fever subsided. All investigations including chest x-ray and echo were normal. He was discharged from hospital but mild on and off fever (101 F) and cough is still persisting. At present his TLC is 9000 with 8-10 pus cells in urine. He is taking Septran for the last 2 days. What could be the reason for persisting cough and fever? Is repeat throat swab for H1N1 required? Can a 5-day course with Tamiflu be repeated?

A:The fact that your friend had very high white cell count means that he had a bacterial infection in addition to the HINI. The likely sites of infection were chest and urinary tract. Since Tamiflu was already administered (although a little late in the course of illness) there is no role of another course of Tamiflu as per the current recommendations. Urine shows persistence of pus cells-choose an antibiotic as per the culture report. A repeat HINI screening need not be done.