Emergency Med

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CDC Updates Recommendations for Antiviral Use. Physicians Can Take Steps to Speed Initiation of Treatment for Influenza
American Family Physician, 09/14/09

The CDC is urging physicians to use antiviral medications appropriately to treat influenza during the 2009–10 flu season in order to avoid shortages and development of antiviral resistance. Most children, adolescents and adults with influenza–like illness don't need the medicine. It is people with risk conditions where the illness may get worse or people with severe presentations – like those hospitalized or who have signs of lower respiratory infection or other severe warning signs – who need antivirals. Supplies of the recommended antiviral medications – oseltamivir (Tamiflu) and zanamivir (Relenza) – should be adequate. The agency recommends treatment for patients with confirmed or suspected novel influenza A (H1N1) infection who require hospitalization, as well as for the following groups at high risk for flu–related complications:

• children younger than 5 years of age;
• adults 65 and older;
• people with chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurologic, neuromuscular, or metabolic (including diabetes mellitus) disorders;
• people with immunosuppression, including that caused by medications or HIV infection;
• pregnant women; and
• people younger than 19 years who are receiving long–term aspirin therapy.

Physicians should not wait for laboratory confirmation of illness because antivirals are more effective within 48 hours of onset of illness, and a negative rapid test does not rule out influenza. Physicians provide patients in high–risk groups with prescriptions that could be filled at the onset of flu symptoms after telephone consultation with the physician.
Postexposure antiviral chemoprophylaxis with either oseltamivir or zanamivir still can be considered for

• individuals who are at higher risk for complications from influenza and are close contacts of a person with confirmed, probable or suspected H1N1 or seasonal influenza during that person's infectious period and
• health care personnel, public health workers or first responders who have had a recognized, unprotected close–contact exposure to a person with confirmed, probable or suspected novel H1N1 or seasonal influenza during that person's infectious period.

Extended–duration zanamivir and oseltamivir chemoprophylaxis appears to be highly efficacious for preventing influenza among immunocompetent white and Japanese adults.

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