Monday, October 19, 2009, 13:51 EDT (1:51 PM EDT)
CDCHAN-00299-2009-10-19-ADV-N
Recommendations
for Early Empiric Antiviral Treatment in Persons with Suspected Influenza who
are at Increased Risk of Developing Severe Disease
Summary
Recommendations: When treatment of influenza is indicated in a patient with suspected
influenza, health care providers should initiate
empiric antiviral treatment as soon as possible. Waiting for laboratory confirmation
of influenza to begin treatment with antiviral drugs is not necessary. Patients with a negative rapid influenza
diagnostic test should be considered for treatment if clinically indicated because
a negative rapid influenza test result does not rule out influenza virus
infection. The sensitivity of rapid influenza diagnostic tests for 2009
H1N1 virus can range from 10% to 70%, indicating that false negative results
occur frequently.
Situation
The 2009 pandemic H1N1 influenza virus continues to be the dominant influenza
virus in circulation in the
Who is prioritized for treatment with influenza antiviral drugs?
Most healthy persons (i.e., those without a condition which
puts them at higher risk for complications) who develop an illness consistent
with uncomplicated influenza do not need to be treated with antiviral
medications and will recover without complications.
However, clinical judgment should be the ultimate guide in making antiviral
treatment decisions for ill persons who are not at higher risk for complications
from influenza.
Early empiric treatment with oseltamivir or zanamivir is recommended for
all persons with suspected or confirmed influenza requiring hospitalization. Prompt empiric outpatient antiviral therapy is also recommended for
persons with suspected influenza who have symptoms of lower respiratory tract
illness or clinical deterioration regardless of previous health or age.
Early empiric treatment should be considered for persons with suspected or confirmed influenza who
are at higher risk for complications, even if not hospitalized, including:
-
Children younger than 2 years old
-
Adults 65 years and older
- Pregnant women
- Persons with the following conditions:
- Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), or metabolic disorders (including diabetes mellitus);
- Disorders that that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders)
- Immunosuppression, including that caused by medications or by HIV;
- Persons younger than 19 years of age who are receiving long-term aspirin therapy, because of an increased risk for Reye syndrome.
When should health care providers start treatment with antiviral drugs?
Once the decision to
administer antiviral treatment is made, oseltamivir or zanamivir should be
initiated as soon as possible. Evidence for benefit from antiviral treatment in
studies of seasonal influenza is strongest when treatment is started within 48
hours of illness onset. However, some studies of oseltamivir treatment of
hospitalized patients with seasonal influenza have indicated benefit, including
reductions in mortality or duration of hospitalization, even for patients whose
treatment was started more than 48 hours after illness onset.
When treatment is
indicated, health care providers should
not wait for laboratory confirmation of influenza to begin oseltamivir or
zanamivir treatment of patients with suspected 2009 pandemic H1N1
influenza virus infection. Patients with a negative rapid
influenza diagnostic test should be considered for treatment if clinically
indicated because a negative result does not rule out
influenza virus infection. The sensitivity of
rapid influenza diagnostic tests to detect 2009 H1N1 virus in respiratory
specimens ranges from 10% to 70%, and therefore false negative results occur
frequently. Similarly, false negative results can also occur with immunoflorescence
assays.
What actions should health care providers take when
waiting for influenza test results?
Health care providers should empirically
treat persons with suspected influenza illness who are at increased risk for
complications if clinically indicated while influenza test results are pending. Antiviral treatment is
most effective when administered as early as possible in the course of illness.
The
rRT-PCR tests are the most sensitive and specific influenza diagnostic tests,
but they may not be readily available, obtaining test results may take one to
several days, and test performance depends on the individual rRT-PCR assay. Antiviral
treatment should not be delayed until rRT-PCR test results are available.
For More Information
Updated Interim Recommendations for the Use of Antiviral
Medications in the Treatment and Prevention of Influenza for the 2009-2010
Season: http://www.cdc.gov/H1N1flu/recommendations.htm
Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season: http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm
Questions & Answers: Antiviral Drugs: Summary of Side Effects: http://www.cdc.gov/flu/protect/antiviral/sideeffects.htm
General information for the
public on antiviral drugs is available in 2009 H1N1 and Seasonal Flu: What You
Should Know About Flu Antiviral Drugs at http://www.cdc.gov/H1N1flu/antivirals/geninfo.htm
.
Downloadable brochures and informational
flyers, including one on antiviral drugs, are available at http://www.cdc.gov/h1n1flu/flyers.htm.
For the FDA page on antiviral
influenza drugs:
http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm100228.htm
For
additional information, you can also call CDC's toll-free hotline, 800-CDC-INFO
(800-232-4636) TTY: (888) 232-6348, which is available 24 hours a day, every
day.
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