IMA Guideline: Whom to give oral oseltamivir in flu?

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People with confirmed influenza or with influenza symptoms who are very sick or who are at high risk for influenza complications require rapid treatment.

Hence, doctors are advised to quickly treat suspected influenza with antiviral drugs in high-risk outpatients, those with progressive disease and all hospitalized patients, regardless of a negative rapid influenza diagnostic test (RIDT) and without waiting for results of reverse-transcriptase polymerase chain reaction (PCR). Treatment should not be withheld on the basis of results of RIDTs, as these tests have a high potential for false-negative results.

Tamiflu, oral oseltamivir, known as neuraminidase inhibitor has activity against both influenza A and B viruses.

Early antiviral treatment can shorten the duration of fever and illness symptoms, reduce the risk for complications from influenza, including otitis media in young children and pneumonia requiring antibiotics in adults and also reduce the mortality among hospitalized patients.

Clinical benefit is greatest with early administration of oseltamivir. When indicated, oseltamivir should be started as soon as possible after illness begins, ideally within 48 hours of onset of symptoms. However, antiviral treatment might still provide some benefit in hospitalized patients when started after 48 hours of illness onset.

Guideline

Treatment with oseltamivir is recommended as early as possible for any patient with confirmed or suspected influenza who is (1) hospitalized, (2) has severe, complicated, or progressive illness, or (3) is at higher risk for influenza complications, including the following:

• Children aged younger than 2 years
• Adults aged 65 years and older
• Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematologic (including sickle cell disease), and metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle, such as cerebral palsy, epilepsy, stroke, intellectual disability, 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
• Persons who are morbidly obese (BMI ≥ 40 kg/m2)
• Residents of nursing homes and other chronic-care facilities. [Source Medscape]

Arrange school lectures

Prevention of Swine flu mainly involves implementation of respiratory hygiene, cough etiquettes and hand hygiene.

• Respiratory hygiene: Maintain a distance of at least 3 feet from the person who is coughing and sneezing.
• Cough etiquettes: Cover the mouth and nose with a tissue when you cough and sneeze and put the used tissue in a waste basket. If you do not have a tissue, then cough and sneeze into the upper sleeves and not hands or handkerchief.
• Hand hygiene: This should be frequently performed including before and after every patient contact; contact with potential infectious material and before putting on and after taking of personal protective equipment including gloves. Hand hygiene can be performed by washing with soap and water or by using alcohol based hand rubs. If hands are visibly soiled, then wash with soap and water.

In a survey conducted by Heart Care Foundation of India, of 63 schools, both Public and Govt., involving 6047 students (2817 girls and 3230 boys), 76% of the students (4576) did not know about the role of cough etiquettes in preventing flu. They answered that the best way to cough was either in the hands or in the handkerchief.

Flu is diagnosed when the person suffers from cough and cold. Only sore throat is not a sign of flu. Flu patients do not require antibiotics. Unless cough and cold is associated with breathlessness, it does not require hospital admission.

Treat swine flu like ordinary flu

• Swine flu is like ordinary flu, symptoms of which are fever, coryza, cough, sore throat, bodyache and malaise. Occasionally, nausea, vomiting, diarrhea and rash may also be present.
• Severe breathlessness, blood on coughing are ominous signs and need investigation and/or hospitalization. Symptoms ordinarily last for 1-2 weeks.
• Cases of fever with coryza and breathlessness should not be neglected, and need admission in isolation and investigation for influenza (swine or otherwise). Influenza normally has its outbreaks intermittently especially seasonal outbreaks are common.
• Influenza vaccines can prevent flu caused by human strains, which is recommended for children above 6 months; adults > 50 years of age; patients with pulmonary, cardiovascular, renal, hepatic, neurologic, hematologic disorders and diabetes mellitus; pregnant females and health care providers.
• The inactivated vaccine can be given to the above groups. The Live attenuated influenza vaccine (intranasal spray) can be given only to persons aged 2-49 years (not to pregnant females).
• Current seasonal influenza vaccines are not expected to provide protection against human infection with avian or swine influenza A viruses. However, reducing seasonal influenza risk via influenza vaccination of persons who might be exposed to nonhuman influenza viruses (e.g. H5N1 viruses) might reduce the theoretical risk for recombination of influenza A viruses of animal origin and human influenza A viruses by preventing seasonal influenza A virus infection within a human host.