WHO: Treat Severe And Progressive H1N1 Flu With Antivirals

ACEP News
October 2009

Physicians should use oseltamivir to treat patients with severe or progressive cases of infection with the pandemic influenza A(H1N1) virus. If that drug is unavailable or if the virus demonstrates resistance to it, treat with zanamivir, international public health officials said.

That advice, given by the World Health Organization in an updated guideline on the treatment of flu viruses, applies to all patients, including pregnant women, children younger than 5 years, and neonates.

At-risk patients--those infants and children aged less than 5 years, people over the age of 65 years, nursing home residents, pregnant women, and those who have chronic comorbid conditions or immunosuppression--should be treated with one of these agents if they have mild to moderate uncomplicated clinical presentations. Physicians need not prescribe antivirals for otherwise healthy individuals (those deemed not "at risk") who have mild to moderate cases of the viral infection.

Where the risk of complications from infections is high--either from the virus strain or the baseline risk of the exposed group--the drugs might be used as postexposure chemoprophylaxis for at-risk individuals and for health care workers. If the complication risk is low, chemoprophylaxis need not be offered to these groups.

The guidelines represent the consensus of an international panel evaluating evidence on the use of antivirals in a pandemic, including treatment of the pandemic H1N1 virus circulating globally. It follows initial recommendations made in May.

--Jonathan Gardner

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