Clinical Reminder - Antiviral Guidance

[sharon sanders]

hat tip Senior Moderator Kent Nickell via email -


In response to events surrounding the novel influenza A (H1N1) outbreak, we would like to provide you with the following information. Please share this information with other interested parties.
If you have any questions on these or other clinical issues, please write to us at coca@cdc.gov.

• Clinical Reminder - Antiviral Guidance
• COCA Conference Call
• MMWR Reports

Clinical Reminder - Antiviral Guidance

CDC recommends that antiviral treatment for novel influenza A (H1N1) be given as soon as possible after onset of symptoms for all hospitalized patients with confirmed, probable or suspected novel influenza (H1N1) and patients who are at higher risk for seasonal influenza complications. All hospitalized patients with novel influenza A (H1N1) infection should be monitored carefully and treated with antiviral therapy, including patients who seek care >48 hours after illness onset .


A recent study published in MMWR described diagnosis, medical conditions and treatment of 30 hospitalized patients in California with novel influenza A (H1N1) infection. The report indicated that 50% of 30 hospitalized patients received antiviral treatment with oseltamivir, and treatment was initiated within 48 hours of symptom onset in only 5 (16.6%) patients.
Among hospitalized patients with novel influenza A (H1N1), about half who have had chest x-rays done have findings consistent with pneumonia. Primary influenza virus pneumonia, with or without bacterial coinfection, is a potentially life-threatening illness. Empiric use of influenza antiviral medicines should be initiated as soon as possible for maximum benefit.

If bacterial coinfection is suspected, antibacterials directed at likely pathogens such as S. aureus and S. pneumoniae should also be initiated after appropriate bacteria cultures are taken.

Antiviral Treatment for Novel (H1N1) Influenza http://www.cdc.gov/h1n1flu/recommendations.htm


MMWR: Hospitalized Patients with Novel Influenza A (H1N1) Virus Infection --- May 18, 2009 / 58(Early Release);1-5 California, April--May, 2009 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0518a1.htm

 

[The Mountains Voice]

Re: Clinical Reminder - Antiviral Guidance

CDC recommends that antiviral treatment for novel influenza A (H1N1) be given as soon as possible after onset of symptoms for all hospitalized patients with confirmed, probable or suspected novel influenza (H1N1) and patients who are at higher risk for seasonal influenza complications. All hospitalized patients with novel influenza A (H1N1) infection should be monitored carefully and treated with antiviral therapy, including patients who seek care >48 hours after illness onset .

I agree wholeheartedly with what I see as the underlined recent addition to talking points coming out of CDC. Now the word needs to filter down to actual doctors. Under the current situation it is practically IMPOSSIBLE to be tested and confirmed with H1N1 within the 48 hour window. The ENTIRE BENEFIT OF TAMIFLU IS THEN LOST. This is an issue that has greatly concerned me - and needs to have some sort of forceful and rapid guidance from the CDC. All of the doctors I have spoken to have scoffed at the notion of giving out Tamiflu unless it becomes acritical care situation, and H1N1 confirmed. IT'S TOO LATE THEN!!!!

A solution to this must be addressed quickly.
CDC MUST TAKE THE PUBLIC LEAD!

 

[Desolation_anonymous]

Re: Clinical Reminder - Antiviral Guidance

I agree wholeheartedly with what I see as the underlined recent addition to talking points coming out of CDC. Now the word needs to filter down to actual doctors. Under the current situation it is practically IMPOSSIBLE to be tested and confirmed with H1N1 within the 48 hour window. The ENTIRE BENEFIT OF TAMIFLU IS THEN LOST. This is an issue that has greatly concerned me - and needs to have some sort of forceful and rapid guidance from the CDC. All of the doctors I have spoken to have scoffed at the notion of giving out Tamiflu unless it becomes acritical care situation, and H1N1 confirmed. IT'S TOO LATE THEN!!!!

A solution to this must be addressed quickly.
CDC MUST TAKE THE PUBLIC LEAD!

In addition, Kaiser Permanente WILL NOT (from first hand experience and talking with Pediatrician who consulted their Infectious Disease Specialist, AND speaking to and Infection Diseas Specialist)
1) Test for the Flu
2) Give Antivirals to ANYONE- EVEN HIGH RISK PATIENTS- unless they are SICK ENOUGH TO BE HOSPITALIZED (IMO stupid because cases usually don't get that sick until several days in- when Tamiflu no longer works)
3) Consider it the flu unless there is a fever of over 102 degrees