This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Google Scholar Articles by Bradley, J. S. Articles by Bocchini, J. A. Social Bookmarking                         What's this?

 Previous Article  |  Next Article 

NEWS AND FEATURES

CDC offers new guidance on use of antivirals

The Centers for Disease Control and Prevention, with the support and assistance of many organizations including the Academy, posted new antiviral recommendations for 2009 H1N1 influenza (swine flu) as of Sept. 22: www.cdc.gov/h1n1flu/recommendations.htm.

For pediatric practitioners, the most important changes are:

• The pediatric age group at high risk of complications has been redefined from under 5 years to under 2 years.
  
• Antiviral treatment after 48 hours of influenza symptoms may be considered for any child with more serious influenza illness, regardless of the need for hospitalization. Keep in mind that maximal treatment benefit is achieved when initiated within 48 hours of illness onset.
  
• Oseltamivir (Tamiflu) pediatric suspension requires measuring devices marked with the same dosing units (mg or mL) as those the physician directs for use by the family, written on the prescription.
  

Key recommendations to keep in mind are:

1. Early empiric treatment with oseltamivir or zanamivir should be considered for children with suspected or confirmed influenza who are at high risk for complications, regardless of the severity of infection, including:

• children younger than 2 years of age;
  
• pregnant adolescents and young women;
  
• children and adolescents of any age with chronic medical or immunosuppressive conditions;
  
• children who are receiving long-term aspirin therapy.
  

2. Children 2 through 4 years of age are more likely to require urgent medical evaluation or hospitalization for influenza compared with older children, although the risk is notably lower than for children younger than 2 years old. Children aged 2 through 4 years without high-risk conditions and with mild illness do not necessarily require antiviral treatment. Clinical judgment should play a role in such a decision.

3. Treatment, when indicated, should be initiated as early as possible because studies show that treatment initiated within 48 hours of illness onset is more likely to provide benefit.

4. Actions that should be taken to reduce delays in treatment initiation include:

• informing families with children at high risk for complications of signs and symptoms of influenza and need for early treatment after onset of influenza-like illness (i.e., fever, respiratory symptoms);
  
• ensuring rapid access to telephone consultation and clinical evaluation for any patient who reports more severe illness;
  
• considering empiric treatment of patients at high risk for influenza complications based on telephone contact if hospitalization is not indicated and if this will substantially reduce delay before treatment is initiated.
  

5. Treatment should not wait for laboratory confirmation of influenza because laboratory testing can delay treatment. In addition, a negative rapid test for influenza does not rule out influenza. The sensitivity of rapid tests in detecting 2009 H1N1 influenza has ranged from 10% to 70%.

6. Testing for 2009 H1N1 influenza infection at local and state health departments with real-time reverse transcriptase-polymerase chain reaction should be prioritized for persons with suspected or confirmed influenza requiring hospitalization and based on local guidelines. However, these tests are available commercially from many laboratories and hospitals.

7. Early treatment at the onset of influenza symptoms is an important alternative to chemoprophylaxis after suspected exposure. Consideration for antiviral chemoprophylaxis generally should be reserved for persons at higher risk for influenza-related complications who have had contact with influenza-like illness. Household or close contacts of confirmed or suspected cases can be counseled about the early signs and symptoms of influenza; they should be advised to contact their health care provider immediately for evaluation and possible early treatment once clinical signs or symptoms develop.

Drs. Bradley and Bernstein are members of the AAP Committee on Infectious Diseases (COID). Dr. Bocchini is chair of COID.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Google Scholar Articles by Bradley, J. S. Articles by Bocchini, J. A. Social Bookmarking                         What's this?