The Use Of Antiviral Drugs For Influenza Flashcards
How does the flu affect children differently than adults
Higher rates in school-age children
Atypical non-specific nature of flu illness in young children
High risk for adverse outcomes in <5yo
What group has the highest rates of hospitalization
<6mo
What antivirals are available in Canada, and what are their indications
- Amantadine - flu A, high resistance rates
- Oseltamvir - flu A and B, oral, for >1yo
- Zanamivir -flu A and B, diskhaler or IV
- Peramivir - flu A and B, IV **only for severe cases when other options can not be used
When should antivirals be used?
Hospitalized children
Underlying medical condition
Severe or progressive symptoms of influenza
Should antivirals be used as prophylaxis?
Only in specific clinical scenarios, with consultation with PH and ID
What are risk factors for influenza complications or hospitalization
<59mo
All >6mo, adolescences, adults with chronic health conditions
Indigenous persons
Residents of chronic care facilities
Pregnant women, including adolescents, in all trimesters
All adults >65yo
What constitutes a chronic health condition placing an individual at high risk for influenza
Cardiac, pulmonary disorders - including: BPD, CF, asthma, conditions with high risk aspiration DM and other metabolic disorders Renal disease Anemia, hemoglobinopathies Cancer, immune-compromising conditions Obesity - BMI >40 or BMI z-score >3SD for age and gendre Neurological or NDD conditions Prolonged ASA therapy
If a healthy person, with mild self-limited influenza symptoms >48h in duration receive antivirals?
No
If symptoms have been going on for >48h - when should antivirals be started?
Requires hospitalization
Progressive illness
Severe or complicated disease
Individual is high risk for severe disease
What is the duration of therapy for antivirals
5d
**should be stopped if empirically started and testing is negative
What do you do if mild disease, no risk factors and
- <1yo
- 1-5yo
- > 5y
- antivirals aren’t approved, vaccinate close contacts/pregnant women
- Treatment is optional as they are high risk for disease, BUT if otherwise healthy and no other risk factors, and not need hospitalisation, do not need to start therapy
- Not routinely recommended if healthy, and mild disease
What do you do if mild disease and risk factors other than age for severe influenza in:
- <1yo
- > 1yo and <48h of symptoms
- > 1yo and >48h of symptoms
- NAIs are not approved
- Can use oseltamivir or inhaled zanamivir (if >7yo)
- Case-by-case consideration for NAIs
What do you do if have moderate, progressive, severe, complicated influenza with or without risk factors
- Decide if needs hospitalisation and or ICU
- Start antivirals, even if >48h of symptoms
- Use zanamivir IF not responding to oseltamivir or illness despite oseltamivir ppx
- If <1yo: consider on case-by-case basis
What is the dosing for oseltamivir
- <15kg: 30mg BID
- > 15-23kg: 45mg BID
- > 23-40kg: 60mg BID
- > 40kg (adults): 75mg BID
**same dosing once daily IF for chemoprophylaxis - give for 10d
What is the dosing in <12mo IF you were going to use it
3mg/kg/dose twice daily
