Part two will cover the important basics about the flu treatment, chemoprophylaxis, high risk patient population w/ the flu management. This is a compilation of information provided by the CDC along with reference papers that have been clinically relevant as they have been referenced multiple times over the last few weeks during my rotation in the ED.
Note that Tamiflu is now FDA approved for patients age 2-weeks and older (FDA NEWS RELEASE link)
Oseltamivir is preferred for treatment of pregnant women. Pregnant women are recommended to receive the same antiviral dosing as nonpregnant persons
- Zanamivir might be preferred by some providers because of its limited systemic absorption; however, respiratory complications that might be associated with zanamivir because of its inhaled route of administration need to be considered, especially in women at risk for respiratory problems
- Pregnant women are known to be at higher risk for complications from infection with seasonal influenza viruses and severe disease among pregnant women was reported during past pandemics
- Oseltamivir, zanamivir, rimantadine, and amantadine are “Pregnancy Category C” medications, indicating that data from clinical studies are not adequate to assess the safety of these medications for pregnant women
Persons w/ impaired renal function
Oseltamivir: For patients with creatinine clearance of 10–30 mL per minute, a reduction of the treatment dosage of oseltamivir to 75 mg once daily and in the chemoprophylaxis dosage to 75 mg every other day is recommended
- Serum concentrations of oseltamivir carboxylate, the active metabolite of oseltamivir, increase with declining renal function.
Person w/ Immunosuppression
- oseltamivir was safe and well tolerated when used during the control of an influenza outbreak among hematopoietic stem cell transplant recipients living in a residential facility
- Source: (retrospective study: Vu D, Peck AJ, Nichols WG, et al. Safety and tolerability of oseltamivir prophylaxis in hematopoietic stem cell transplant recipients: a retrospective casecontrol study. Clin Infect Dis 2007;45:187–93.)