Antiviral Recommendations for H1N1

Antiviral Recommendations for H1N1

The World Health Organization (WHO) has issued a global alert and response regarding the use of antivirals for pandemic H1N1 flu, reiterating that antivirals should be used to prevent severe illness and death in children and adults. The neuraminidase inhibitor oseltamivir (Tamiflu^®) is recommended for patients who initially present with severe illness or whose condition begins to deteriorate. H1N1 remains sensitive to the neuraminidase inhibitors such as oseltamivir despite isolated reports of resistance earlier this year. The WHO recommends that clinicians in communities where the virus is circulating widely assume that patients with flu-like symptoms have H1N1 and not wait for laboratory confirmation. Most patients with pandemic flu experience typical flu symptoms and recover within a week. These patients do not need antivirals. But in patients with severe illness, studies have shown that early treatment, within the first 48 hours, is associated with better clinical outcomes. WHO also states that if oseltamivir is unavailable zanamivir (Relenza^®) may be used in its place. This recommendation applies to all patient groups including children and pregnant women. The WHO statement comes in response to an article in the British Medical Journal suggesting neuraminidase inhibitors provide minimal benefit for children with seasonal influenza and have little effect on asthmatic exacerbations or use of antibiotics (Shun-Shin M, et al. BMJ 2009;339:b3172).