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Table: Interim Recommendations for the Selection of Antiviral Treatment Using Laboratory Test Results and Viral Surveillance Data, United States, 2008-09 season‡




This table is part of a Health Alert Advisory issued on December 19, 2008 entitled Interim Recommendations for the Use of Influenza Antiviral Medications in the Setting of Oseltamivir Resistance among Circulating Influenza A (H1N1) Viruses, 2008-09 Influenza Season." Visit http://www.cdc.gov/flu/professionals/antivirals/index.htm for the full content of the interim recommendations.

Table: Interim Recommendations for the Selection of Antiviral Treatment Using Laboratory Test Results and Viral Surveillance Data, United States, 2008-09 season‡
 
Rapid antigen or other laboratory test Predominant virus(es) in community Preferred medication(s) Alternative (combination antiviral treatment)
Not done or negative, but clinical suspicion for influenza H1N1 or unknown Zanamivir Oseltamivir + Rimantadine*
Not done or negative, but clinical suspicion for influenza H3N2 or B Oseltamivir or Zanamivir None
Positive A H1N1 or unknown Zanamivir Oseltamivir + Rimantadine*
Positive A H3N2 or B Oseltamivir or Zanamivir None
Positive B Any Oseltamivir or Zanamivir None
Positive A+B** H1N1 or unknown Zanamivir Oseltamivir + Rimantadine*
Positive A+B** H3N2 or B Oseltamivir or Zanamivir None

*Amantadine can be substituted for rimantadine but has increased risk of adverse events. Human data are lacking to support the benefits of combination antiviral treatment of influenza; however, these interim recommendations are intended to assist clinicians treating patients who might be infected with oseltamivir-resistant influenza A (H1N1) virus.

**Positive A+B indicates a rapid antigen test that cannot distinguish between influenza and influenza B viruses

‡ Influenza antiviral medications used for treatment are most beneficial when initiated within the first two days of illness. Clinicians should consult the package insert of each antiviral medication for specific dosing information, approved indications and ages, contraindications/warnings/precautions, and adverse effects.


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