H1N1 Flu Treatment

What is H1N1 Flu Treatment?

Most cases of flu require no treatment other than symptom relief. If you have a chronic condition such as respiratory or heart disease your doctor may prescribe additional medication to manage symptoms.

Antivirals
Influenza is sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza), both of which are neuraminidase inhibitors. These antiviral drugs can reduce the severity of symptoms and are most effective if treatment begins within 48 hours of developing symptoms.

Healthy individuals with H1N1 infection do not require treatment with antivirals.

Treatment with either oseltamivir or zanamivir is recommended as soon as possible for suspected or confirmed influenza in people who:

•Are hospitalized
•Show signs or symptoms of lower respiratory tract illness, such as shortness of breath or rapid breathing
•Are younger than 5 years of age
•Are 65 years and older
•Are pregnant
•Are younger than 19 years of age and are receiving long-term aspirin therapy, because of an increased risk for Reye syndrome
•Have certain chronic medical conditions: Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurologic, neuromuscular, or metabolic disorders (including diabetes mellitus)
•Have suppression of the immune system due to medications or HIV infection or AIDS
Self-Care
If you develop symptoms of influenza but you’re otherwise healthy:

•Stay home from work or school. Anyone who tests positive for Influenza A at this time of the year can be presumed to have H1N1. The CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]), or signs of a fever without the use of fever-reducing medications. In addition, the CDC recommends that health care workers with H1N1 remain off work for seven days from the onset of symptoms or until fever is gone, whichever is longer.
•Drink plenty of liquids.
•Rest. Get more sleep to help your immune system fight infection.
•Consider pain relievers. Use an over-the-counter pain reliever such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) cautiously, as needed.
Remember, pain relievers may make you more comfortable, but they won’t make your symptoms go away any faster, and pain relievers may have side effects. Ibuprofen may cause stomach pain, bleeding and ulcers. If taken for a long period or in higher than recommended doses, acetaminophen can be toxic to your liver.

Talk to your doctor before giving acetaminophen to children. And don’t give aspirin to children or teens because of the risk of Reye’s syndrome, a rare but potentially fatal disease.

What Is the Recommended Treatment for Children 1 Year of Age and Older?

•For those with a confirmed or probable S-OIV infection, antiviral treatment with oseltamivir or zanamivir is recommended and should be initiated as soon as possible after the onset of symptoms. (For case definitions, go to www.cdc.gov/h1n1flu/casedef_swineflu. htm)
•The recommended duration of treatment is 5 days, but that may change as data on antiviral effectiveness, side effects, and antiviral susceptibilities become available. Recommended antiviral doses for treatment of S-OIV infection are the same as those recommended for seasonal influenza and can be found at http://www.cdc. gov/h1n1flu/childrentreatment.htm
•For children older than 1 year with suspected cases of swine influenza A (H1N1) virus infection, especially those with severe illness, empiric antiviral treatment is also recommended.
How Should Children Younger Than 1 Year Be Treated?
Currently, there are only limited safety data available on the use of oseltamivir or zanamivir for seasonal influenza in this age group, and oseltamivir is not licensed for use in children younger than 1 year.

Because infants typically have high rates of morbidity and mortality from influenza, however, the CDC reports that infants with S-OIV infections may benefit from treatment with oseltamivir. In fact, under an Emergency Use Authorization (EUA), oseltamivir was recently approved by the US Food and Drug Administration for use in children younger than 1 year.

The dosing recommendations for treating S-OIV influenza in infants are now:

•< 3 months old = oseltamivir 12 mg twice daily
•3-5 months old = oseltamivir 20 mg twice daily
•6-11 months old = oseltamivir 25 mg twice daily
When considering fever-reducing medications, the CDC recommends the following:

•Do not administer aspirin or aspirin-containing products for confirmed or suspected case of influenza A (H1N1) virus infection in any child 18 years of age or younger due to the risk for life-threatening Reye’s syndrome.
•Instead, antipyretic medications such as acetaminophen or nonsteroidal anti-inflammatory drugs are recommended for the relief of fever.
What Are the Current Antiviral Chemoprophylaxis Guidelines for This Group?
Antiviral chemoprophylaxis is currently recommended for:

•Children with household contacts with confirmed, probable, or suspected cases of H1N1 infection;
•School children or daycare attendees who are at high risk for complications of influenza and who have had face-to-face contact with a confirmed, probable, or suspected case of H1N1 influenza;
•Children who traveled to Mexico recently and are at high risk for complications of influenza; and
•Children with chronic medical conditions.
The CDC’s current chemoprophylaxis treatment recommendations are:

•For children 1 year of age or older, treatment with either oseltamivir or zanamivir is recommended for antiviral chemoprophylaxis of S-OIV infection.
•For those 3-11 months of age, oseltamivir can be used under an EUA (at doses of 20 mg once daily for those 3-5 months of age and 25 mg once daily for those 6-11 months of age).
•For infants younger than 3 months, chemoprophylaxis is not recommended unless the situation is judged to be critical.
Chemoprophylaxis should be given during a potential exposure period and should be continued for 10 days after the last known exposure to a confirmed case of H1N1 infection.

Children With Special Conditions
In regard to seasonal influenza, certain children are more at risk for complications. In fact, a recent study found that almost half of the children who died from influenced-related causes had an underlying medical condition. These conditions include immunosuppression, chronic kidney disease, heart disease, HIV and AIDS, diabetes, asthma or problems with the lungs, sickle cell disease, and chronic neurologic conditions, cerebral palsy, and seizure disorders.

Another high-risk group of children includes those with poor nutritional or fluid intakes because of prolonged vomiting and diarrhea, as well as children with an underlying metabolic disorder.

These children should be particularly monitored for symptoms of influenza. Additional guidance for children with special healthcare needs is expected to be posted on the CDC site soon.

H1N1 (Swine Flu) Treatment Options for People With Cancer

For most people, the best treatment for H1N1 (swine flu) is probably what your grandmother would recommend. Rest and fluids. But for those living with cancer, breathing difficulties and side effects of chemotherapy such as bone marrow suppression, can make the infection riskier. If you develop symptoms suggestive of the H1N1 flu with cancer, check with your doctor as soon as possible to see if she thinks a medication would be helpful.

H1N1 (Swine Flu) Treatment – Supportive Care
The mainstay of treatment for the H1N1 flu is supportive care – taking care of your body while it heals itself. It is easy to say, but taking time to pamper yourself until you feel better, can go a long way in preventing more serious complications of the flu. Try to:

•Drink plenty of fluids. Keep a glass of water handy when you are resting. Filling a pitcher with water in the fridge can be a reminder if you aren’t drinking enough.
•Get enough rest. Daytime naps can be helpful if flu symptoms interfere with your sleep at night.
•A bowl of chicken soup might be just what the doctor ordered.
•Stay home. People are being told to stay home to prevent spreading the flu, but it also gives you more opportunity to care for yourself.
H1N1 (Swine Flu) Treatment – Medications for H1N1 Flu
Two medications are currently available to treat the H1N1 flu. The Centers for Disease Control and Prevention (CDC) recommends that these drugs be reserved for people who are severely ill with the swine flu, or for those people with illnesses such as cancer who are at significant risk from the infection. Since these medications are most effective if taken within 48 hours after symptoms begin, it is important to contact your doctor as soon as you believe you may have the swine flu. Neither of these medications work immediately, but they do appear to shorten the duration of the illness by a day or so. Medications include:
•Oseltamivir (Tamiflu) – Oseltamivir is taken orally twice a day for 5 days. Side effects can include nausea and vomiting, and occasionally, mood changes.

•Zanamivar (Relenza) – Zanamivar is used twice a day for 5 days as an inhaled medication. Since it can cause airways to spasm, it isn’t recommended for people with lung problems such as lung cancer and asthma.

H1N1 Flu: Understanding Treatment Options

Two antiviral medications, oseltamivir (Tamiflu) and zanamivir (Relenza) are active against the H1N1 strain of virus and can be used to treat those who have been diagnosed with (or are strongly suspected of having) this infection. It is important that the use of these medications is started as soon as possible (within 48 hours of the onset of symptoms) if they are to be effective. When used for treating infection, these medications are usually administered twice a day for five days. They do not immediately relieve symptoms, but may shorten the duration of symptoms by approximately one day, on average. There has been some recent publicity that the intravenous administration of a single dose of another antiviral agent has been highly effective in treating H1N1 flu. However, this drug is still being evaluated and is not commercially available.

•Tamiflu is available in capsules and in a liquid formulation that are given by mouth and swallowed. It has been studied and approved for use in adults and children at least one year of age. Some patients experience nausea and vomiting, and there have been rare reports of neurologic/psychiatric adverse events (e.g., delirium) although it has not been proven that the drug was responsible for these effects.
•Relenza is administered by oral inhalation and its use in the treatment of influenza has been studied and approved in patients 7 years of age and older. It is generally recommended that Relenza not be used in patients with asthma, chronic obstructive pulmonary disease (COPD), or other conditions that may be associated with bronchospasm.
Individuals who experience symptoms such as sneezing, nasal congestion, or coughing that may be associated with the flu should speak with a pharmacist, physician, or other health professional. It may be that these symptoms are not due to a flu infection, but rather have developed because of an allergy or common cold, and can be effectively treated with a nonprescription product.