Flu Fighters: Guidelines for Antiviral Treatment of Flu Patients

TMA Flu Fighters Offer Guidance on Battling the Flu

TMA’s Flu Fighters want you to have the latest information on the 2013-14 seasonal influenza. While you are likely receiving a great deal of information on influenza, the Flu Fighters cull through the national and state guidance and data for you, and highlight key messages and important guidance for your patients.
 
Follow These Guidelines for Antiviral Treatment of Flu Patients
 
Antiviral treatment can shorten the duration of symptoms and may reduce risk of complications from influenza, including those resulting in hospitalization and death. 
 
You should offer treatment as early as possible for any person with suspected or confirmed flu who: 
  • Has severe, complicated, or progressive illness;  
  • Is hospitalized; or
  • Is at higher risk for influenza complications.     
 
Earlier antiviral treatment provides optimal clinical responses. However, antiviral treatment still can be beneficial in patients with severe, complicated, or progressive illness and in hospitalized patients, even if started after 48 hours of illness onset. You also can consider antiviral treatment for any previously healthy, symptomatic outpatient not at high risk with confirmed or suspected influenza on the basis of clinical judgment. 
 
Please view from the CDC: Recommended Dosage and Duration of Treatment or Chemoprophylaxis for Influenza Antiviral Medications 

Risk groups. Antiviral treatment is recommended for people at higher risk for complications from influenza infection. This includes: 

  • Children under 2 years;
  • Adults 65 and older;
  • Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematologic (including sickle cell), metabolic (including diabetes), or neurologic conditions (including stroke, epilepsy, cerebral palsy, moderate-severe developmental delay); 
  • Persons with immunosuppression;
  • Women who are pregnant or postpartum (within two weeks after delivery);
  • Persons who are morbidly obese (BMI ≥40);
  • Persons younger than 19 years who are receiving long-term aspirin therapy; and 
  • Residents of nursing homes 

Consider Treating Co-Infections

Influenza infections can cause primary viral pneumonias and exacerbate underlying medical conditions (e.g., pulmonary or cardiac disease). Bacterial infections (e.g., secondary bacterial pneumonia, sinusitis, otitis media, or other serious suppurative infections of the upper respiratory tract) also can occur concurrently with influenza or after influenza infection. Therefore, consider antibiotic therapy in flu patients with suspected bacterial co-infections. 

Consider Treating Serious Illness With Zanamivir Aqueous Solution

Zanamivir aqueous solution, a product of GlaxoSmithKline, is available on a compassionate use basis for treatment of serious influenza illness in hospitalized patients. This intravenous product is not an approved product but is currently under investigation in clinical trials. Clinicians can contact the GSK Clinical Support Help Desk for information on how to obtain zanamivir aqueous solution and any further requirements: (877) 626-8019 or (866) 341-9160.

How to Compound an Oral Suspension

The Food and Drug Administration is reporting a temporary shortage of the liquid formulation of oseltamivir (Tamiflu™) in some areas of the United States. In the event of an emergency, follow these instructions for compounding an oral suspension from Tamiflu 75-mg capsules. 

Remind Your High-Risk Patients About Vaccination

High risk persons, such as oncology patients, may need a reminder that the flu shot (inactivated influenza vaccine) is safe for them to receive, does not contain live virus, and will not cause flu-like illness. Particularly encourage their family members and caregivers to get vaccinated as well.

Do you have a question for the TMA Flu Fighters? Contact the TMA Knowledge Center with your question at (800) 880-7955 or email knowledge@texmed.org.

The Flu Fighters are Wendy Chung, MD, SM, Dallas County Health and Human Services’ chief epidemiologist and chair of TMA’s Committee on Infectious Diseases (CID); Lisa Cornelius, MD, MPH, infectious diseases, medical officer, Texas Department of State Health Services; Bruno P. Granwehr, MD, MS, The University of Texas MD Anderson Cancer Center, Houston; Gilberto Handal, MD, pediatrics, Texas Tech University Health Science Center, El Paso; Philip P. Huang, MD, MPH, medical director, Austin/Travis County Health and Human Services; Charles J. Lerner, MD, infectious disease consultant to CID, San Antonio; Donald Murphey, MD, medical director, pediatric infectious diseases, Cook Children’s Medical Center, Fort Worth; Seema Shah, MD, MPH, Department of Medicine, The Methodist Hospital, Houston; and Jane Siegel, MD, pediatric infectious diseases, Children’s Medical Center, Dallas.

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