Its not that only swine flu needs anti viral drugs

Saturday 8 August 2009: HCFI New Delhi: The decision of the government that tamiflu will be reserved only for H1Ni and will be given only through govt. outlets needs scientific discussion said Dr KK Aggarwal President Heart care Foundation of India, BSNL Dil Ka Darbar, MTNL Perfect Health Mela and Member FAITH.

All flu are same as far as developing complications are concerned and need same consideration for treatment. In complicated flu weather swine or human there is no difference in the line of treatment and both will need tamiflu, which is currently the drug of choice in view of the sensitivity patterns. If tamiflu will be out of circulation of the private sector and the government will take care of only swine flu cases than what will happen to severe non swine human flu with pneumonia. Won?t they die for want of tamiflu.

In flu the decision of whom to treat with antiviral is made on a case-by-case basis based on the patient's individual risk for influenza complications, the severity of illness, and the time since onset of symptoms (in uncomplicated cases). Preference is given to those at highest risk for influenza complications (e.g., lung transplant recipients, individuals with advanced HIV infection [CD4<200 cells/microL], hematopoietic stem cell transplant recipients).

Given the concerning trends of increasing resistance with the adamantanes and oseltamivir, the risk of promoting antiviral drug resistance should be considered when deciding which patients to treat. Antiviral therapy can shorten the duration of illness and severity of symptoms when initiated within the first 48 hours of symptom onset.
   
The current practice is to take antiviral treatment by patients who present with
uncomplicated influenza within 48 hours of symptom onset and who wish to take medication.

One should treat all women who have influenza during the third trimester of pregnancy, as well as all women with co morbidities who have influenza during the second trimester of pregnancy. Co morbidities that increase the risk of influenza complications in pregnant women include chronic cardiac or pulmonary disease, diabetes mellitus, chronic renal disease, malignancy, and immunosuppression.
   
The current recommendation is that patients with uncomplicated influenza who have had more than 48 hours of influenza signs and symptoms NOT be treated with antivirals.
   
In patients who present past 48 hours start treatment in the following groups: Patients who are severely ill and patients who are at high risk for complications of influenza and have not yet started to improve.

Choice of antiviral
1.    Clinicians should review local or state influenza surveillance data during influenza season to determine which types of influenza (A or B) and subtypes of influenza A (H1N1 or H3N2) are circulating.
2.    For patients in whom influenza therapy is indicated (and in whom oseltamivir-resistant influenza is not suspected), one can start  oseltamivir or  zanamivir as first-line agents.
3.    In patients with oseltamivir-resistant influenza, zanamivir remains effective.
4.    In such cases one can start influenza therapy with rimantidine (or  amantadine) in combination with oseltamivir in patients who have a contraindication to zanamivir (e.g., asthma or chronic obstructive pulmonary disease) who require treatment during an outbreak of suspected oseltamivir-resistant influenza.
5.    The recommended dose of zanamivir is 10 mg [two inhalations] twice daily; the recommended dose of oseltamivir is 75 mg twice daily. Since oseltamivir is primarily excreted by the kidneys, dosing must be modified in the setting of renal insufficiency. The recommended duration of therapy for either drug is five days.
6.     Because of the high rates of influenza isolates resistant to adamantanes in the United States and in many other countries, amantadine and rimantadine are generally no longer useful for the treatment of influenza. An exception occurs in suspected outbreaks of oseltamivir-resistant influenza in patients who have a contraindication to zanamivir.