Influenza Antiviral Medications: Summary for Clinicians | Seasonal Influenza (Flu)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. Five licensed prescription influenza antiviral agents are available in the United States. Three influenza antiviral medications approved by the U. S. Food and Drug Administration (FDA) are recommended for use in the United States during the 2.
Tamiflu®), inhaled zanamivir (trade name Relenza®), and intravenous peramivir (trade name Rapivab®). These drugs are chemically related antiviral medications known as neuraminidase inhibitors that have activity against both influenza A and B viruses. Generic oseltamivir was approved by the FDA in August and became available in December of 2. Amantadine and rimantadine are antiviral drugs in a class of medications known as adamantanes. These medications are active against influenza A viruses, but not influenza B viruses. As in recent past seasons, there continues to be high levels of resistance (> 9. A (H3. N2) and influenza A (H1. N1) pdm. 09 (“2. 00.
H1. N1”) viruses. Therefore, amantadine and rimantadine are not recommended for antiviral treatment or chemoprophylaxis of currently circulating influenza A viruses. Antiviral resistance to oseltamivir, zanamivir, and peramivir among circulating influenza viruses is currently low, but this can change. Also, antiviral resistance can emerge during or after treatment in some patients (e. Table 1. Antiviral Medications Recommended for Treatment and Chemoprophylaxis of Influenza. Antiviral Agent. Activity Against. Use. Recommended For.
Not Recommended for Use in. Adverse Events. Oral. Oseltamivir. Influenza A and BTreatment. Any age. 1N/AAdverse events: nausea, vomiting. Post marketing reports of serious skin reactions and sporadic, transient neuropsychiatric events (self- injury or delirium; mainly reported among Japanese adolescents and adults).
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Chemo- prophylaxis. N/AInhaled. Zanamivir.
WHO’s Initiative for Vaccine Research (IVR) facilitates vaccine research and development (R&D) against pathogens with significant disease and economic burden, with.
Influenza A and BTreatment. COPD)2. Allergic reactions: oropharyngeal or facial edema. Adverse events: diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose and throat infections. Chemo- prophylaxis. COPD)2. Intravenous.
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- The Holistic Health Movement will eventually relegate the Vaccine Industry, and all similar aberrations of nature, to the dust-bin of history.
- A vaccine is a biological preparation that provides active acquired immunity to a particular disease. A vaccine typically contains an agent that resembles a disease.
Peramivir. Influenza A and B3. Treatment. 2 yrs and older. N/AAdverse events: diarrhea. Post marketing reports of serious skin reactions and sporadic, transient neuropsychiatric events (self- injury or delirium; mainly reported among Japanese adolescents and adults). Chemo- prophylaxis. N/AN/AAbbreviations: N/A = not applicable, COPD = chronic obstructive pulmonary disease. Oral oseltamivir is approved by the FDA for treatment of acute uncomplicated influenza in persons 1.
Although not part of the FDA- approved indications, use of oral oseltamivir for treatment of influenza in infants less than 1. CDC and the American Academy of Pediatrics. If a child is younger than 3 months old, use of oseltamivir for chemoprophylaxis is not recommended unless the situation is judged critical due to limited data in this age group. Relenza is contraindicated in patients with history of allergy to milk protein. Peramivir efficacy is based on clinical trials in which the predominant influenza virus type was influenza A; a limited number of subjects infected with influenza B virus were enrolled. Top of Page. Summary of Influenza Antiviral Treatment Recommendations. Clinical trials and observational data show that early antiviral treatment can shorten the duration of fever and illness symptoms, and may reduce the risk of complications from influenza (e.
Early treatment of hospitalized patients can reduce death. In hospitalized children, early antiviral treatment has been shown to shorten the duration of hospitalization. Clinical benefit is greatest when antiviral treatment is administered early, especially within 4.
Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who. Table 2. Persons at higher risk for influenza complications who are recommended for antiviral treatment. Persons at higher risk for influenza complications recommended for antiviral treatment include: children aged younger than 2 years; 1adults aged 6. HIV infection; women who are pregnant or postpartum (within 2 weeks after delivery); persons aged younger than 1.
American Indians/Alaska Natives; persons who are morbidly obese (i. Adapted from Fiore, 2.
Antiviral Agents for the Treatment and Chemoprophylaxis of Influenza – Recommendations of the Advisory Committee on Immunization Practices (ACIP). PDF Version)1 Although all children aged younger than 5 years are considered at higher risk for complications from influenza, the highest risk is for those aged younger than 2 years, with the highest hospitalization and death rates among infants aged younger than 6 months. Because many children with mild febrile respiratory illness might have other viral infections (e. Clinical judgment, on the basis of the patient’s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for high- risk outpatients. When indicated, antiviral treatment should be started as soon as possible after illness onset, ideally within 4. However, antiviral treatment might have some benefits in patients with severe, complicated or progressive illness, and in hospitalized patients when started after 4.
Observational studies in hospitalized patients with influenza have reported that clinical benefit is greatest when oseltamivir is started within 4. Hsu, 2. 01. 2; Louie, 2. Muthuri, 2. 01. 3; Muthuri, 2.
However, some studies suggest that antiviral treatment might still be beneficial in hospitalized patients when started up to 4 or 5 days after illness onset (Louie, 2. Yu, 2. 01. 1). Antiviral treatment of pregnant women (of any trimester) with influenza A (2. H1. N1) virus infection has been shown to be most beneficial in preventing respiratory failure and death when started within less than 3 days of illness onset, but still provided benefit when started 3–4 days after onset compared to 5 or more days (Siston, 2. Decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza (see section on Diagnostic Testing for Influenza).
While influenza vaccination is the first and best way to prevent influenza illness, a history of influenza vaccination does not rule out the possibility of influenza virus infection in an ill patient with clinical signs and symptoms compatible with influenza. Antiviral treatment also can be considered for any previously healthy, symptomatic outpatient not at high risk with confirmed or suspected influenza on the basis of clinical judgment, if treatment can be initiated within 4. One randomized clinical trial in children with uncomplicated influenza demonstrated a modest reduction in duration of symptoms and virus shedding in patients initiating treatment after 4.
Fry, 2. 01. 4). For outpatients with acute uncomplicated influenza, oral oseltamivir, inhaled zanamivir, or intravenous peramivir may be used for treatment. The recommended treatment course for uncomplicated influenza is two doses per day of oral oseltamivir or inhaled zanamivir for 5 days, or one dose of intravenous peramivir for 1 day. Oral oseltamivir is preferred for treatment of pregnant women (Rasmussen, 2. Pregnant women are recommended to receive the same antiviral dosing as non- pregnant persons.
See Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for additional information. In a randomized controlled clinical trial, a single dose of intravenous peramivir shortened duration of influenza symptoms when used for treatment of outpatient adults with uncomplicated influenza by about 1 day (Kohno, 2. Whitley, 2. 01. 4). Top of Page. Treatment Considerations for Patients Hospitalized with Suspected or Confirmed Influenza. Treatment of patients with severe influenza (e.