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NEWS AND FEATURES

Clinicians reminded to offer antiviral treatment for H1N1

Preliminary information has shown that a number of hospitalized patients are either not being treated with the antivirals or are receiving them late, such as after confirmatory testing. In addition, some patients with pneumonia and influenza symptoms have failed to receive antivirals early in their illness.

Although data shows early antiviral treatment (within 48 hours of onset of symptoms) is most effective, clinicians should initiate therapy at the earliest possible time, including at hospital admission for those not previously treated.

Influenza can cause primary viral pneumonia, so early antiviral treatment is desirable.

Empiric treatment with influenza antivirals does not preclude empiric treatment for bacterial co-infections, according to the CDC.

Influenza testing should be performed for any hospitalized patient with suspected H1N1 flu.

The CDC recommends antiviral therapy for the following groups:

1. All hospitalized patients with suspected, probable or confirmed novel influenza A (H1N1) virus infection should be empirically treated with oseltamivir or zanamivir as early after illness onset as possible. (For pediatric dosages, see link below.)

2. All outpatients with suspected H1N1 influenza who are at higher risk for influenza complications should be empirically treated with oseltamivir or zanamivir as early after illness onset as possible.

3. Groups with a higher risk for influenza complications include:

• Children younger than 5 years old (2 years old and younger have the highest risk);
  
• Adults 65 years of age and older;
  
• Persons with the following conditions:

  – Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurologic, neuromuscular or metabolic disorders (including diabetes mellitus);
  

  – Immunosuppression, including that caused by medications or by HIV;
  

  – Pregnant women;
  

  – Persons younger than 19 years of age who are receiving long-term aspirin therapy; and
  

  – Residents of nursing homes and other chronic-care facilities.
  

  
  

For more information on the CDC’s antiviral recommendations, including dosages and special considerations for children, visit: http://www.cdc.gov/h1n1flu/recommendations.htm.

Access the CDC’s H1N1 testing recommendations at: http://www.cdc.gov/h1n1flu/specimencollection.htm.

Visit this AAP Web page for resources and links to information on H1N1 influenza: http://www.aap.org/new/swineflu.htm.

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