Wednesday, December 9, 2009

CDC: Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment 2009 H1N1

The CDC has posted updated recommendations on their website for clinical treatment of 2009 H1N1. Below are some highlights from the document.

Who to treat

Prompt empiric treatment is recommended for persons with suspected or confirmed influenza and:

  • Illness requiring hospitalization
  • Progressive, severe, or complicated illness, regardless of previous health status, and/or
  • Patients at risk for severe disease (see below for groups at high risk)

How to treat

  • Antiviral drugs: oseltamivir (oral), zanamivir (inhaled)
  • Initiate treatment as early as possible after onset of symptoms
  • Treat empirically before diagnostic test results are reported
  • When definitive diagnosis is indicated, request definitive diagnostic tests (rRT-PCR*, viral culture) rather than rapid tests (RIDT*, DFA*)
Clinical Assessment

While most persons who have had confirmed or suspected 2009 H1N1 influenza have had a mild, uncomplicated self-limited respiratory illness similar to typical seasonal influenza and while persons not considered to be at increased risk of developing severe or complicated illness may not require treatment, they can be considered for antiviral treatment. Benefits of treating such patients might include a reduced duration of illness. However, based on experience with seasonal influenza treatment, patients not considered to be at increased risk of developing severe or complicated illness and who have mild, uncomplicated illness are not likely to benefit from treatment if initiated more than 48 hours after illness onset. Clinical judgment is always an essential part of treatment decisions.

People who are already recovering from influenza do not need antiviral medications for treatment. Options for close follow-up should be carefully considered. Clinicians who prefer not to treat empirically should discuss signs and symptoms of worsening illness with such patients and arrange for follow up at least by telephone.

Clinical algorithm for consideration in the assessment of persons with mild or uncomplicated influenza illness

Source: CDC

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