Questions & Answers

Revised Recommendations for the Use of Influenza Antiviral Drugs

September 8, 2009 2:00 PM ET

Background

On September 8, 2009 CDC updated its recommendations for the use of influenza antiviral medicines to provide additional guidance for clinicians in prescribing antiviral medicines for treatment and prevention (chemoprophylaxis) of influenza during the upcoming 2009-2010 flu season. These recommendations are intended to help clinicians prioritize use of antiviral drugs for treatment and prevention of influenza. In general, the priority for the use of antiviral medications this season continues to be in persons at increased risk of influenza-related complications as outlined in the antiviral recommendations posted on May 6, 2009.

How is the new guidance different from the guidance that was issued on May 6, 2009?

The priority use for antiviral medications during the upcoming influenza season remains the same as outlined in the antiviral recommendations posted on May 6, 2009; that is to prioritize use of these drugs for those patients who are severely ill (hospitalized) and those patients who are ill with influenza-like illness and who are at high risk for influenza related complications. The updated guidance provides additional context and guidance for clinicians in an effort to ensure that antiviral drugs are prescribed appropriately this season and that they reach those in greatest need quickly. This includes actions that clinicians may consider taking to reduce possible delays between illness onset in high risk patients and treatment, including a suggestion that clinicians consider providing pre scriptions for antiviral medications ahead of time for such patients. In addition, the updated guidance provides more information about the appropriate (and limited) situations in which antiviral medications should be used for chemoprophylaxis (prevention) this season. The updated guidance states that antiviral drugs should not be used for prevention in healthy persons based on community exposures. In addition, the guidance places an emphasis on the use of antiviral drugs for early treatment (versus preventatively). The updated recommendations seek a balance between providing clinicians the information and guidance needed to reach those at greatest risk with appropriate and timely treatment; to reduce the chances of antiviral-resistance through inappropriate or unnecessary chemoprophylaxis; and yet to still recognize the overarching importance of clinical judgment in making treatment and chemoprophylaxis decisions.

What are influenza antiviral drugs?

Influenza antiviral drugs are pre scription drugs (pills, liquid, or inhaler) that decrease the ability of flu viruses to reproduce. While getting a flu vaccine each year is the first and most important step in protecting against flu, antiviral drugs are a second line of defense in the prevention and treatment of flu.

Who is prioritized for treatment with influenza antiviral drugs?

Most people ill with influenza will recover without complications. 

Some people are at increased risk of influenza complications and are prioritized for treatment with influenza antiviral drugs this season. They include:

• People hospitalized with suspected or confirmed influenza
• People with suspected or confirmed influenza who are at higher risk for complications
  • Children younger than 5 years old (children under 2 years old are at higher risk for complications than older children)
  • Adults 65 years and older
  • Pregnant women
  • People with certain chronic medical or immunosuppressive conditions
• People younger than 19 years of age who are receiving long-term aspirin therapy

Physicians may also decide not to treat some people in these groups and/or treat people who are not in these groups based on their clinical judgment.

Who is lower priority for treatment with influenza antiviral drugs?

Treatment with influenza antiviral drugs is generally not needed for people who are not at higher risk for complications or do not have severe influenza, such as those requiring hospitalization. However, any suspected influenza patient who presents with emergency warning signs (for example, difficulty breathing or shortness of breath) or signs of lower respiratory tract illness should promptly receive antiviral therapy. Doctors may treat some people who are not in a high risk group based on their clinical judgment. In addition, doctors also may decide that treatment is not needed for some who are in a high risk group based on their clinical judgment.

Which influenza antiviral drugs should be used for treatment this season?

At this time, treatment with oseltamivir (trade name Tamiflu