Remember antiviral drugs for flu, CDC tells clinicians

In the battle against influenza, clinicians aren’t prescribing antiviral medications as much as they should, Centers for Disease Control and Prevention (CDC) Director Tom Frieden, MD, MPH, told members of the media this afternoon in a press call. The CDC issued new recommendations this morning to encourage use of the drugs, which the CDC considers an important adjunct to vaccination, he noted.

The antiviral medications can help prevent hospitalization, a transfer to the intensive care unit for those who are hospitalized, and even death, Frieden said. Use of the medications is even more important than usual, he added—especially in those aged more than 65 years, those with chronic conditions such as asthma or diabetes, and other vulnerable populations—given that the prominent strain of flu this season is H3N2, which leads to severe illness.

“One recent study showed that fewer than one out of five high-risk outpatients who clearly should have gotten treatment…with antivirals actually did,” Frieden said. Several factors may explain why doctors, nurse practitioners, physician assistants and other healthcare professionals are not prescribing antiviral drugs to fight the flu, he added:

• They may not be aware of CDC recommendations.
• They may not be aware of the drugs’ effectiveness.
• They may be waiting for the results of tests confirming flu in patients/residents. (“Don’t wait,” he said. “Early treatment is essential and keeps the benefit higher.”)
• The two-day window of the drugs’ optimal benefit, during which the medications are most likely to reduce the intensity and duration of illness, may have passed.

Flu season typically lasts 13 weeks, and this season’s outbreak is in week seven, Frieden noted. The flu is widespread across the country but seems to be declining in areas of the country that experienced the earliest cases of illness, he added, although “it’s too soon to say if we’ve peaked.”

Frieden said the CDC continues to recommend vaccination for those who haven’t yet received a flu shot, even though this year’s vaccine wasn’t formulated to fight the H3N2 virus. Vaccination is especially important for those aged 65 or more years, who tend to be hospitalized or die more than others due to the flu, he said. “Despite the likelihood that vaccine effectiveness will be lower this year…vaccination may still offer some protection, and there are other strains out there as well,” he said.

Those who have the flu should cover their cough and stay home and away from others to prevent the spread of illness. Those who are prescribed antiviral medications should be sure to take the full course, he added. Those who care for the sick should ensure that they receive the full course.

The CDC also recommends two pneumococcal vaccinations for those aged 65 or more years, Frieden said. “The best way to prevent pneumococcal disease is by getting vaccinated,” he added.

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