The neuraminidase inhibitors are the drugs of choice for treatment of H1N1 influenza and influenza-like illness in both children and adults in the U. In addition, the EUA authorizes treatment of patients symptomatic with H1N1 influenza for more than 2 days and patients sick enough to require hospitalization see www.
As with oseltamivir, the FDA has issued an EUA authorizing treatment with zanamivir of patients with H1N1 influenza who have been symptomatic for more than 2 days and patients sick enough to require hospitalization see www. Peramivir - A third neuraminidase inhibitor peramivir formulated for intravenous IV administration is an investigational product currently being evaluated in clinical trials. Efficacy and safety have not been evaluated in hospitalized patients.
Even though the data are insufficient to allow FDA approval, the FDA issued an EUA for treatment with peramivir of hospitalized patients with H1N1 influenza who have potentially life-threatening suspected or laboratory confirmed infection.
Under the EUA, treatment of adult patients with IV peramivir is approved only if: 1 the patient has not responded to either oral or inhaled antiviral therapy; 2 drug delivery by a route other than IV is not expected to be dependable or is not feasible; or 3 the clinician judges IV therapy is appropriate due to other circumstances.
Treatment of pediatric patients is approved if either of the first two criteria apply. Treatment is recommended for patients with confirmed or suspected H1N1 influenza who have severe, complicated, or progressive illness or who are hospitalized. The recommended duration of treatment is 5 days. Hospitalized patients with severe infections such as those with prolonged infection or who require intensive care unit admission might require longer treatment courses. Even though treatment is most effective when started in the first 48 hours of illness, limited data from observational studies of hospitalized patients suggests treatment of persons with prolonged or severe illness reduces mortality or duration of hospitalization even when treatment is started more than 48 hours after onset of illness.
Antiviral doses recommended for treatment of H1N1 influenza in adults or children 1 year of age or older are the same as those recommended for seasonal influenza Table 1. Some experts have advocated use of doubled doses of oseltamivir for some severely ill patients, although there are no published data demonstrating that higher doses are more effective.
For patients unable to take oral medication or in whom oral medication appears to be ineffective, peramivir for intravenous administration is available from the CDC under an FDA EUA, although studies of efficacy and safety are limited. Prompt empiric antiviral drug treatment is recommended for persons with confirmed or suspected influenza who are at increased risk for serious morbidity and mortality.
Children: Children younger than 2 years of age are at higher risk for influenza-related complications and have a higher rate of hospitalization compared to older children. Children aged 2 to 4 years are more likely to require hospitalization or urgent medical evaluation for influenza compared with older children and adults, although the risk is much lower than for children younger than 2 years old.
From April through September hospitalization rates for laboratory-confirmed H1N1 influenza were 4. Use of oseltamivir in children younger than 1 year is subject to the terms and conditions of the EUA. Retrospective safety data on oseltamivir treatment of seasonal influenza in children younger than 1 year old are limited and suggest that severe adverse events are rare.
Prospective data continue to be collected on safety and efficacy of oseltamivir in this age group. Dosing for children younger than 1 year is based on the EUA guidance. Details are provided in Table 1 , below. Children and adolescents under 19 years of age who are receiving long-term aspirin therapy are also at increased risk. Adults aged 65 years and older: Even though persons aged 65 years and older are less likely to become ill with H1N1 influenza compared to younger persons, when they do acquire influenza, they are at higher risk for severe influenza-related complications.
Pregnant women: Pregnancy increases the risk of complications, hospitalization, and severe disease. One study estimated the risk of hospitalization for H1N1 to be four times higher for pregnant women than for the general population Jamieson DJ, et al. While oseltamivir and zanamivir are "Pregnancy Category C" medications, meaning no clinical studies have been conducted to assess the safety of these medications for pregnant women, available data suggest pregnant women with suspected or confirmed influenza should receive prompt antiviral therapy, and pregnancy should not be considered a contraindication to treatment with oseltamivir or zanamivir.
Oseltamivir is preferred for treatment of pregnant women because of its systemic activity. Anecdotal reports suggest postpartum women, similar to pregnant women, might be at increased risk for severe complications and death from H1N1 influenza.
The transition to normal immune, cardiac, and respiratory function occurs quickly, but not immediately after delivery. Therefore, the increased risk associated with pregnancy should be considered to extend for 2 weeks postpartum regardless of the outcome of the pregnancy including live birth, premature birth, termination of pregnancy, miscarriage, fetal death.
Prompt empiric antiviral treatment is indicated for suspected or confirmed H1N1 influenza in women who are up to 2 weeks postpartum regardless of how the pregnancy ended. Medical conditions : The following medical conditions have been associated with increased risk of complications from influenza:. Local public health authorities might provide additional guidance about prioritizing treatment within groups at higher risk for severe infection.
While most persons who have had confirmed or suspected 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.
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Full Disclaimer. This site complies with the HONcode standard for trustworthy health information: verify here. Facebook Twitter Pinterest Linkedin. List of drugs used to treat the medical condition called Swine Flu. Click on the drug to find more information including the brand names,dose,side-effects, adverse events, when to take the drug and the price of the drug. Baloxavir marboxil tablets are prescribed to treat flu or acute uncomplicated influenza in patients who are aged 12 years and above.
Oseltamivir is a neuraminidase inhibitor, prescribed for the treatment and prevention of flu. Peramivir is prescribed for the treatment of acute uncomplicated influenza in patients 18 years of age and above who have had the symptoms for not more than 2 days.
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