Influenza Treatment and Chemoprophylaxis

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Influenza Treatment and Chemoprophylaxis

• October 2, 2009

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Who Should Be Treated?

• Most cases have been mild and self-limited
• Limited supplies of antiviral medication
• Therefore, treatment is reserved for
• Patients requiring hospitalization
• Ambulatory patients at high risk for complications

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Intranet Flu Treatment Flow Chart
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For Hospitalized Patients Who Should Be Treated?

• Decision to hospitalize
• Clinical judgment
• Red flags dyspnea, hypotension
• Treat with antiviral irrespective of illness
  duration
• Provide antibiotics per syndrome recommendations

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For Hospitalized Patients In Whom Should the Flu
Be Suspected?

• Influenza-like illness (ILI) criteria met in only
  about 50 of inpatients with confirmed influenza
• Our experience
• Hospitalized cases were often admitted for CHF or
  asthma/COPD exacerbations
• Many were missed until after ward admission

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For Hospitalized PatientsUniversal
Precautions for Respiratory Illnesses During Flu
Epidemics

• Consider influenza in the differential diagnosis
  of all patients with acute respiratory illness
• Bottom line testing isolation treating

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Influenza Careset in Cernerfor Stroger
Inpatients
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For Non-Hospitalized Patients Who Should Be
Treated?

• Patients should meet all four criteria
• Symptomatic for 48 hours
• Documented fever (gt 100.0 F)
• At least one respiratory symptom (cough, sore
  throat or nasal congestion)
• AND any of the following
• Age lt 5 or 65 years
• Chronic medical/neurological conditions
• Immunosuppression
• Pregnancy
• Nursing home/chronic care facility resident
• Chronic aspirin recipients lt 18 years old

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Influenza TherapyA Moving Target
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Antiviral Therapy forHospitalized Patients

• Begin oseltamivir at initial point of care
• Antiviral recommendations will change per drug
  supplies, antiviral susceptibilities
• Begin antibiotics as appropriate for syndrome
• Antiviral dose pack to travel with patient to
  admitting ward
• Zanamivir to be given by respiratory therapy

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Antiviral Therapy forNon-Hospitalized Patients

• Prescribe oseltamivir at point of care
• Antiviral recommendations will change per drug
  supplies, antiviral susceptibilities
• Observe administration of 1st dose
• Educate patient in self-administration
• Send medication dose pack home with patient

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Stroger ED Procedure
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Oseltamivir for Adults

• 75 mg capsules
• 1 PO q 12 hours for 5 days (10)
• For creatinine clearance 10-30 ml/min
• 1 PO daily for 5 days (5)
• For dialysis patients oseltamivir suspension, 75
  mg x 1, repeat 4 days later
• GI side effects (10) mitigated with food

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Oseltamivir for Children

• Different formulations
• Compounded from pharmacy from 75 mg capsules (15
  mg/ml)
• As 30 or 45 mg capsules (can be emptied into
  beverage
• As pediatric solution (12 mg/ml)
• Check CCHHS internet site or call pharmacy for
  current formulation

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Oseltamivir for Children
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Antiviral Chemoprophylaxis

• Exposures warranting consideration all four
  conditions must be met
• Within the last 48 hours
• CLOSE (within 3 feet) contact
• Not wearing personal protective equipment AND
• Index patient has confirmed or probable influenza
• Persons warranting consideration
• Healthcare workers
• Other essential personnel (e.g., police)
• Elderly, immunocompromised, comorbidities

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Oseltamivir Chemoprophylaxis Regimen

• Treat once daily for 10 days from the day of last
  exposure

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Questions?

• Hospital intranet
• ID Treatment Guidelines
• Antibiotic approval pager 333-1704
• ID consultant on call 760-0526
• Dr. Schwartz
• [phone] office
• david.schwartz_at_hektoen.org