Categories
  Encyclosphere.org ENCYCLOREADER
  supported by EncyclosphereKSF

Influenza medical therapy

From Wikidoc - Reading time: 7 min

Influenza Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Influenza from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

Other Diagnostic Studies

Treatment

Medical Therapy

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Influenza medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Influenza medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Influenza medical therapy

CDC on Influenza medical therapy

Influenza medical therapy in the news

Blogs on Influenza medical therapy

Directions to Hospitals Treating Influenza

Risk calculators and risk factors for Influenza medical therapy

For more information about non-human (variant) influenza viruses that may be transmitted to humans, see Zoonotic influenza

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

[edit | edit source]

Antiviral therapy is recommended for patients who are at higher risk of complications from the Influenza virus. Antiviral drugs diminish symptoms, shorten the time of the disease, and prevent serious complications. The two main antiviral agents used in the treatment and prevention of influenza are Oseltamivir and Zanamivir. For the majority of patients, the treatment of influenza is primarily symptomatic and includes Analgesics, Antihistamines, Decongestants and cough suppressants.

Medical Therapy

[edit | edit source]

Antiviral Medications

[edit | edit source]
Persons at higher risk for influenza complications recommended for antiviral treatment include:
  • Children aged younger than 2 years
  • Adults aged 65 years and older
  • Persons with the following comorbidities:
  • Chronic pulmonary (including asthma)
  • Cardiovascular (except hypertension alone)
  • Renal, hepatic, hematological (including sickle cell disease) or metabolic disorders (including diabetes mellitus)
  • Neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy, stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury)
  • Persons with immunosuppression, including that caused by medications or by HIV infection
  • Women who are pregnant or postpartum (within 2 weeks after delivery)
  • Persons aged younger than 19 years who are receiving long-term aspirin therapy
  • American Indians/Alaska Natives
  • Persons who are morbidly obese (BMI > 40)
  • Residents of nursing homes and other chronic-care facilities.
  • Antiviral medications with activity against influenza viruses are an important adjunct to influenza vaccine in the control of influenza.
  • Influenza antiviral prescription drugs can be used to treat influenza or to prevent influenza.
  • Four licensed prescription influenza antiviral agents are available in the United States.

Neuraminidase inhibitors

  • Two FDA-approved influenza antiviral medications are recommended for use in the United States during the 2013-2014 influenza season:
  • Oseltamivir and zanamivir are chemically related antiviral medications known as neuraminidase inhibitors that have activity against both influenza A and B viruses.

 Adamantanes

  • Amantadine and rimantadine are antiviral drugs in a class of medications known as adamantanes.
  • Adamantanes are active against influenza A viruses, but not influenza B viruses.

Antiviral Therapy Recommendations

[edit | edit source]

Antiviral treatment with neuraminidase inhibitors is recommended as early as possible for any patient with confirmed or suspected influenza who has any of the follwing conditions:

  • Is hospitalized.
  • Has severe, complicated, or progressive illness.
  • Is at higher risk for influenza complications (detailed in the table on the right).


Meta-analyses of randomized controlled trials of neuraminidase inhibitors conflict with reviews by the Cochrane Collaboration[1] suggesting less benefit than reviews by industry[2]:

  • "median times to alleviation were 97·5 h for oseltamivir and 122·7 h for placebo groups (difference -25·2 h, 95% CI -36·2 to -16·0)" [2]
  • "a reduction in the time to first alleviation of symptoms from 7 to 6.3 days"[1]

The Cochrane assessment has evolved:

  • 2000: "Eight trials with 1180 adults were included." "As a treatment, NIs shorten the duration of symptoms by one da...NIs are effective for the prevention and treatment of influenza. Overall NIs are safe..."[3]
  • 2006: "We identified four prophylaxis, 13 treatment and four post-exposure prophylaxis (PEP) trials." "Because of their low effectiveness, NIs should not be used in routine seasonal influenza control"[4]
  • 2012: "We included and analysed data from 25 studies (15 oseltamivir and 10 zanamivir studies). We could not use data from a further 42 studies due to insufficient information or unresolved discrepancies in their data." "We found a high risk of publication and reporting biases in the trial programme of oseltamivir."[5]
  • 2014: "We obtained 107 clinical study reports from the European Medicines Agency (EMA), GlaxoSmithKline and Roche." "Oseltamivir and zanamivir have small, non-specific effects on reducing the time to alleviation of influenzasymptoms in adults, but not in asthmatic children."[1]

A subsequent, open-label trial found[6]:

  • "Primary care patients with influenza-like illness treated with oseltamivir recovered one day sooner on average than those managed by usual care alone"
  • "The effect does not appear to be mediated by influenza virus status, as measured using PCR analysis of swabs"

Drug Resistance

[edit | edit source]
  • Antiviral resistance to oseltamivir and zanamivir among circulating influenza viruses is currently low, but this might change.
  • Also, antiviral resistance can emerge during or after treatment in certain patients, such as immunosuppressed individuals.
  • As in recent past seasons, there is a high prevalence (>99%) of influenza A(H3N2) and influenza A(H1N1) (2009 H1N1) viruses resistant to adamantanes.
  • Therefore, amantadine and rimantadine are not recommended for antiviral treatment or chemoprophylaxis of currently circulating influenza A viruses.
[edit | edit source]
Antiviral Agent Activity Against Use Recommended For Not Recommended for Use in Adverse Reactions
Oseltamivir (Tamiflu®) Influenza A and B Treatment Any age N/A Nausea, vomiting. Sporadic, transient neuropsychiatric events (self injury or delirium) mainly reported among Japanese adolescents and adults.
Prophylaxis > 3 months of age N/A
Zanamivir (Relenza®) Influenza A and B Treatment > 7 years old Patients with underlying respiratory disease, such as asthma or COPD Allergic reactions such as oropharyngeal or facial edema. Diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose and throat infections.
Prophylaxis > 5 years old Patients with underlying respiratory disease, such as asthma or COPD
Table adapted from CDC [7]
[edit | edit source]
Antiviral Agent Patient Treatment (5 days) Prophylaxis (7 days)
Oseltamivir
(Tamiflu®) 		Children
  • < 1 yr: 3 mg/kg/dose twice daily
  • > 1 yr: dose depends on weight.
  • ≤ 15 kg: 30 mg twice a day
  • > 15 to 23 kg: 45 mg twice a day
  • > 23 to 40 kg: 60 mg twice a day
  • > 40 kg: 75 mg twice a day
  • Not recommended for children < 3 months old.
  • 3 months to 1 yr: 3 mg/kg/dose once daily
  • > 1 yr: dose depends on weight.
  • ≤ 15 kg: 30 mg once a day
  • > 15 to 23 kg: 45 mg once a day
  • > 23 to 40 kg: 60 mg once a day
  • > 40 kg: 75 mg once a day
Adults
  • 75 mg twice a day
  • 75 mg once a day
Zanamivir
(Relenza®) 		Children For children > 7 yrs old.
  • 10 mg (two 5-mg inhalations) twice daily
 For children > 7 yrs old.
  • 10 mg (two 5-mg inhalations) once daily
Adults
  • 10 mg (two 5-mg inhalations) twice daily
  • 10 mg (two 5-mg inhalations) once daily
Peramivir (Rapivab®) Children N/A N/A
Adults 600 mg IV for 15-30 minutes (single dose) N/A
Table adapted from CDC (as of 2015) [7]
[edit | edit source]
Antiviral Agent Creatinine Clearance Recommended Treatment Regimen Recommended Chemoprophylaxis Regimen
Oral Oseltamivir Creatinine clearance 61 to 90 mL/min 75 mg twice a day 75 mg once daily
Creatinine clearance 31 to 60 mL/min 30 mg twice a day 30 mg once daily
Creatinine clearance 10 to 30 mL/min 30 mg once daily 30 mg every other day
ESRD Patients on Hemodialysis (Creatinine clearance ≤10 mL/min) 30 mg after every hemodialysis cycle. Treatment duration not to exceed 5 days 30 mg after alternate hemodialysis cycles
ESRD Patients on Continuous Ambulatory Peritoneal Dialysis (Creatinine clearance ≤10 mL/min) A single 30 mg dose administered immediately after a dialysis exchange 30 mg once weekly immediately after dialysis exchange
Intravenous Peramivir (single dose) Creatinine clearance > 50 mL/min 600 mg N/A
Creatinine clearance 30-49 mL/min 200 mg N/A
Creatinine clearance 10-29 mL/min 100 mg N/A
ESRD Patients on Hemodialysis Dose administered after dialysis at a dose adjusted based on creatinine clearance

Symptomatic Therapy

[edit | edit source]

Over the counter (OTC) medicines may be taken to relieve influenza symptoms, but they do not affect the virus. [8]

Symptom(s) OTC Medicine
Fever, Aches, Pains, Sinus pressure, Sore throat Analgesics
Nasal congestion, Sinus pressure Decongestants
Sinus pressure, Runny nose, Watery eyes, Cough Antihistamines
Cough Cough suppressant
Sore throat Local anesthetics
  • Children and teenagers with flu symptoms (particularly fever) should avoid taking aspirin as taking aspirin in the presence of influenza infection (especially Influenzavirus B) can lead to Reye's syndrome, a rare but potentially fatal disease of the liver.[9]

References

[edit | edit source]
  1. ↑ 1.0 1.1 1.2 T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ; et al. (2014). "inhibitors for preventing and treating influenza in healthy adults and children". Cochrane Database Syst Rev (4): CD008965. doi:10.1002/14651858.CD008965.pub4. PMID 24718923. Review in: Evid Based Med. 2014 Dec;19(6):211 Review in: Ann Intern Med. 2014 Oct 21;161(8):JC2
  2. ↑ 2.0 2.1 Dobson J, Whitley RJ, Pocock S, Monto AS (2015). "Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials". Lancet. 385 (9979): 1729–37. doi:10.1016/S0140-6736(14)62449-1. PMID 25640810.
  3. ↑ T, Demicheli V, Deeks J, Rivetti D (2000). "inhibitors for preventing and treating influenza in healthy adults". Cochrane Database Syst Rev (2): CD001265. doi:10.1002/14651858.CD001265. PMID 10796625.
  4. ↑ TO, Demicheli V, Di Pietrantonj C, Jones M, Rivetti D (2006). "inhibitors for preventing and treating influenza in healthy adults". Cochrane Database Syst Rev (3): CD001265. doi:10.1002/14651858.CD001265.pub2. PMID 16855962.
  5. ↑ T, Jones MA, Doshi P, Del Mar CB, Heneghan CJ, Hama R; et al. (2012). "inhibitors for preventing and treating influenza in healthy adults and children". Cochrane Database Syst Rev. 1: CD008965. doi:10.1002/14651858.CD008965.pub3. PMID 22258996. Review in: Ann Intern Med. 2012 Sep 18;157(6):JC3-5
  6. ↑ Butler CC, van der Velden AW, Bongard E, Saville BR, Holmes J, Coenen S; et al. (2020). "Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial". Lancet. 395 (10217): 42–52. doi:10.1016/S0140-6736(19)32982-4. PMID 31839279.
  7. ↑ 7.0 7.1 "CDC Influenza Antiviral Medications: Summary for Clinicians".
  8. ↑ "Cold and Flu Guidelines: Influenza". American Lung Association. Retrieved 2007-09-16.
  9. ↑ Molotsky, Irvin (1986-02-15). "Consumer Saturday - Warning on Flu and Aspirin". New York Times. Retrieved 2007-05-25.

Template:WH Template:WS

Licensed under CC BY-SA 3.0 | Source: https://www.wikidoc.org/index.php/Influenza_medical_therapy
30 views | Status: cached on April 02 2026 09:15:21
↧ Download this article as ZWI file
Encyclosphere.org EncycloReader is supported by the EncyclosphereKSF