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CDC Updated Antiviral Recommendations

 

 

# 3709

 

 

Unlike in the UK - where if you had (or even suspected you had) novel H1N1 symptoms you you called a hotline and were issued a packet of antivirals - here in the U.S. only those with severe illness (generally requiring hospitalization) or serious underlying medical conditions are expected to require the drug.

 

According to Dr. Anne Schuchat in a CDC briefing today, `the vast majority of us that have an influenza-like illness don't need the antiviral medicine.’

 

This press briefing is currently running in a loop on flu.gov, but will shortly be placed on the archived video page.

 

Today’s briefing complements two new documents released by the HHS/CDC today on antiviral medications.

 

 

From the Q&A Document we get this summary of how the guidance has changed since the spring.  I’ve taken the liberty to reformat this statement for readability.

 

How is the new guidance different from the guidance tat was issued on May 6, 2009?

The priority use for antiviral medications during the upcoming influenza season remains the same as outlined in the antiviral recommendations posted on May 6, 2009; that is to prioritize use of these drugs for those patients who are severely ill (hospitalized) and those patients who are ill with influenza-like illness and who are at high risk for influenza related complications.

 

The updated guidance provides additional context and guidance for clinicians in an effort to ensure that antiviral drugs are prescribed appropriately this season and that they reach those in greatest need quickly.

 

This includes actions that clinicians may consider taking to reduce possible delays between illness onset in high risk patients and treatment, including a suggestion that clinicians consider providing prescriptions for antiviral medications ahead of time for such patients. In addition, the updated guidance provides more information about the appropriate (and limited) situations in which antiviral medications should be used for chemoprophylaxis (prevention) this season.

 

The updated guidance states that antiviral drugs should not be used for prevention in healthy persons based on community exposures. In addition, the guidance places an emphasis on the use of antiviral drugs for early treatment (versus preventatively).

 

The updated recommendations seek a balance between providing clinicians the information and guidance needed to reach those at greatest risk with appropriate and timely treatment; to reduce the chances of antiviral-resistance through inappropriate or unnecessary chemoprophylaxis; and yet to still recognize the overarching importance of clinical judgment in making treatment and chemoprophylaxis decisions.

 

 

And from the new guidance, the recommendations as to who should be provided antiviral medications:

 

Summary

  • Treatment with oseltamivir or zanamivir is recommended for all persons with suspected or confirmed influenza requiring hospitalization.

  • Treatment with oseltamivir or zanamivir generally is recommended for persons with suspected or confirmed influenza who are at higher risk for complications (children younger than 5 years old, adults 65 years and older, pregnant women, persons with certain chronic medical or immunosuppressive conditions, and persons younger than 19 years of age who are receiving long-term aspirin therapy.

  • Persons who are not at higher risk for complications or do not have severe influenza requiring hospitalization generally do not require antiviral medications for treatment or prophylaxis. However, any suspected influenza patient presenting with warning symptoms (e.g., dyspnea) or signs (e.g., tachypnea, unexplained oxygen desaturation) for lower respiratory tract illness should promptly receive empiric antiviral therapy.

One of the biggest challenges the American medical system will face this winter will be in providing medical evaluation, care, and antivirals to those that need them in the first 48 hours of their illness.

 


Anyone who has tried to make a doctor’s appointment during flu season knows that the usual response from the receptionist is, “We can see you a week from next Tuesday . . .”

 

Obviously, this is the sort of bottleneck that needs to be fixed, else a great many people are going to end up at their local emergency room seeking medical care.  

 

The CDC has released suggestions to clinicians on how they might better cope with this season’s expected surge in flu patients.

 

Only time will tell if they will be widely adopted by primary care providers, and if so, if they will prove effective.

 

 

Persons at higher risk for complications from influenza or who have already developed severe illness should be treated as quickly as possible after signs or symptoms develop. To reduce delays in starting treatment, health care providers should:

  1. Provide information for patients at higher risk for influenza complications about signs and symptoms of influenza and need for early treatment after symptom onset when ill with influenza;
  2. Ensure rapid access to telephone consultation and clinical evaluation for these patients as well as patients who report severe illness;
  3. Consider empiric treatment of patients at higher risk for influenza complications based on telephone contact if hospitalization is not indicated and if this will substantially reduce delay before treatment is initiated;
  4. Request that patients at higher risk for influenza complications contact the provider if signs or symptoms of influenza develop, obtain the medication as quickly as possible and initiate treatment. In selected circumstances, providers may consider giving a prescription for an influenza antiviral to selected patients who are higher risk for influenza complications. When considering providing a prescription to patients for future use, providers might take into account patient reliability, ability to understand the information about symptoms of influenza, and access to a pharmacy. Providers might prefer to provide a prescription that requires a telephone consultation with the provider before it can be filled.
  5. Counsel patients about influenza antiviral benefits and adverse effects, the potential for continued susceptibility to influenza virus infection after treatment is completed (because of other circulating influenza viruses or if illness was due to another cause), and the need to again seek early access to health care consultation if symptoms recur.

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