Ten people with viral influenza who need antiviral therapy

The Influenza epidemic is still affecting many individuals. Worldwide H1N1 cases are predominating most of the cases. Most patients who develop complications are the aged, children, immunocompromised and the diabetics.

What are the symptoms of Viral influenza?

Patients who develop viral influenza have flu, rhinorrhea, sneezing, and sore throat with a headache. Fever may be low grade initially but may spike to high grade (102 F and 103F). Body aches, myalgias, and arthralgias may dominate in some patients.

Some patients may present with difficulty in breathing and shortness of breath. Others with pre-existing conditions like heart disease and pulmonary disease may simply notice a worsening of their pre-existing conditions.

Immunocompromised patients may develop superimposed bacterial infections like pneumonia and septicemia.

How to prevent oneself from getting a viral influenza?

Individuals should wear a mask to prevent the spread of the virus to other colleagues or family members. Children, pregnant females and old age patients should specifically be kept away from the infected family member. Ideally, the mask should be N95 as it filters particles as small as 0.3 microns.

All individuals aged 6 months and older should get vaccinated against H1N1. People who have allergies to eggs, have hypersensitivity to the vaccine and those who have had an episode of GBS with a prior vaccine should not be vaccinated.

Ten patients who need influenza treatment/ antiviral therapy

Antiviral therapy should be given as an adjunct to supportive care and vaccination. CDC recommends initiation of antiviral therapy as early as possible for any patient with suspected or confirmed influenza who is hospitalized, has complicated or progressive illness, or is at higher risk for influenza complications.

High-risk groups for whom antiviral treatment is recommended include:

Patients with extremes of ages. These include children younger than 2 years of age and those older than 65 years of age.
All patients with chronic lung conditions like COPD, Asthma, bronchiectasis and interstitial lung disease
All patients with ischemic heart diseases especially those with congestive cardiac failure and an ejection fraction of less than 30%
Patients with hematopoietic, renal or liver transplant.
Patients with autoimmune disease especially those on greater than 20 mg of steroids per day.
Patients with immunodeficiency states including those with HIV infections and especially with AIDS.
All patients with diabetes especially those with uncontrolled blood sugars and greater than 50 years of age.
Patients with kidney disease on renal replacement therapy
Emaciated individuals, patients who are obese with a BMI of greater than 40 Kg/m2 and individuals residing in nursing homes.
All pregnant patients and within 2 weeks postpartum.

Ideally, antiviral therapy should be started within 48 hours of the onset of symptoms. Patients who are hospitalized may benefit from antivirals even after 4 to 5 days of symptom onset.

Which antiviral to choose?

Till now four antiviral medications have been approved by the FDA for use in the influenza epidemic this season.

These include

Oral oseltamivir
Intravenous peramivir
Inhaled zanamivir, and
oral baloxavir marboxil

Oral oseltamivir (Tamiflu) is the recommended antiviral therapy for all the hospitalized patients, nonhospitalized patients with severe, complicated, or progressive illness, and pregnant women.

Patients with uncomplicated disease, any of the approved antiviral therapy may be used.

Duration of antiviral therapy

Oral oseltamivir and inhaled zanamivir are recommended for at least five days. Oral oseltamivir is given in doses of 75 mg twice daily. Peramivir is given as a single dose of intravenous infusion. Likewise, baloxavir is given as a single oral dose.

Zanamivir is administered using an inhaler device. It is therefore not recommended for people with breathing problems like asthma or chronic obstructive pulmonary disease.

Oseltamivir is recommended by CDC, IDSA, and the AAP for treatment of influenza in patients of all ages, including infants (although it’s FDA-approved for infants aged 14 days and older).

Peramivir is approved for treatment in people aged 2 years and older, zanamivir for treatment for those aged 7 years and older, and baloxavir for treatment for those aged 12 years and older.