Antiviral agents for the treatment and chemoprophylaxis of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, 1600 Clifton Road, N.E., MS A-20, Atlanta, GA 30333, USA.
MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control 01/2011; 60(1):1-24.
Source: PubMed

ABSTRACT This report updates previous recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of antiviral agents for the prevention and treatment of influenza (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2008;57[No. RR-7]).This report contains information on treatment and chemoprophylaxis of influenza virus infection and provides a summary of the effectiveness and safety of antiviral treatment medications. Highlights include recommendations for use of 1) early antiviral treatment of suspected or confirmed influenza among persons with severe influenza (e.g., those who have severe, complicated, or progressive illness or who require hospitalization); 2) early antiviral treatment of suspected or confirmed influenza among persons at higher risk for influenza complications; and 3) either oseltamivir or zanamivir for persons with influenza caused by 2009 H1N1 virus, influenza A (H3N2) virus, or influenza B virus or when the influenza virus type or influenza A virus subtype is unknown; 4) antiviral medications among children aged <1 year; 5) local influenza testing and influenza surveillance data, when available, to help guide treatment decisions; and 6) consideration of antiviral treatment for outpatients with confirmed or suspected influenza who do not have known risk factors for severe illness, if treatment can be initiated within 48 hours of illness onset. Additional information is available from CDC's influenza website at, including any updates or supplements to these recommendations that might be required during the 2010-11 influenza season. Health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information. Recommendations related to the use of vaccines for the prevention of influenza during the 2010-11 influenza season have been published previously (CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices [ACIP], 2010. MMWR 2010;59[No. RR-8]).

  • Source
    • "Future therapeutic developments may also increase the need for rapid combined RSV and influenza diagnostics. While antiviral treatment is already recommended for infants and children below the age of 2 years (Fiore et al., 2011), there are also several new antivirals in development for RSV-infected infants, children, and adults (Bawage et al., 2013; Geller et al., 2013; Tayyari and Hegele, 2012). The prospect of RSV antivirals or other treatment options, including immune modulators, will further increase the need for rapid diagnostics in the acute care setting (Hurwitz, 2011; Kimpen, 2002). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute respiratory infections represent common pediatric emergencies. Infection control warrants immediate and accurate diagnoses. In the past, first-generation respiratory syncytial virus (RSV) rapid tests (strip tests) have shown suboptimal sensitivities. In 2013, the Food and Drug Administration licensed a second-generation RSV rapid test providing user-independent readouts (SOFIA-RSV) using automated fluorescence assay technology known to yield superior results with influenza rapid testing. We are reporting the first point-of-care evaluation of the SOFIA-RSV rapid test. In the Charite Influenza-Like Disease Cohort, 686 nasopharyngeal samples were tested in parallel with SOFIA-RSV and SOFIA-Influenza A+B. Compared to real-time PCR, SOFIA-RSV sensitivities/specificities were 78.6%/93.9%, respectively (SOFIA-Influenza A: 80.6%/99.3%). Performance was greatest in patients below 2years of age with a test sensitivity of 81.8%. RSV sensitivities were highest (85%) in the first 2days of illness and with nasopharyngeal compared to nasal swabs (P=0.055, McNemar's test). Second-generation RSV and influenza rapid testing provides highly accurate results facilitating timely patient cohortation and management.
    Diagnostic Microbiology and Infectious Disease 12/2014; 81(3). DOI:10.1016/j.diagmicrobio.2014.11.013 · 2.57 Impact Factor
  • Source
    • "Despite longstanding recommendations influenza vaccine uptake remains suboptimal even among high-risk population groups and healthcare workers. As a result influenza cases commonly occur amongst at-risk patients leading to a requirement for antiviral treatment and possibly prophylaxis [7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pharmacokinetic-pharmacodynamic (PKPD) studies have the potential to yield useful information on whether and how a drug works, and what dose to use.This approach is often best suited to situations where dose-response relationships need to be elucidated and where randomisation is not feasible. Children make up around one third of cases during influenza outbreaks, and are more susceptible to certain complications such as otitis media. Despite this, high-quality randomised controlled trials (RCT) of antiviral therapies such as oseltamivir have not been performed, leaving open the question of whether and at what dose to use. This review therefore focusses on the available PKPD data in children. Oseltamivir has complex PK which requires modelling to properly understand the relationship between dose and concentration with time, and there is a lack of clarity on appropriate pharmacodynamic endpoints. Following a general overview of oseltamivir PKPD, this review seeks to summarise the available paediatric PKPD data, identify gaps in our knowledge and priorities for future research.
    05/2013; 13(1). DOI:10.2174/18715265112129990003
  • Source
    • "Treatment of influenza with neuraminidase inhibitor drugs should be initiated early in the course of disease (Coffin et al., 2011; Fiore et al., 2011; Heinonen et al., 2010; Hernan and Lipsitch, 2011; Kaiser et al., 2003; Treanor et al., 2000; Winther et al., 2010) but is underutilized (Fiore et al., 2011; Louie et al., 2012). Timely diagnosis of influenza is challenging (Hoeven et al., 2007; Talbot and Falsey, 2010), and confirmation of influenza infection by rapid influenza detection test can be helpful ( "
    [Show abstract] [Hide abstract]
    ABSTRACT: We evaluated the limits of detection of 3 rapid influenza diagnostic tests-BD Veritor(TM) System for Flu A+B, Binax NOW® Influenza A+B, and QuickVue® Influenza-for influenza strains circulating in 2010-2012. Limits of detection varied by influenza strain, with Veritor(TM) Flu A+B test showing the lowest limit of detection for all strains.
    Diagnostic microbiology and infectious disease 12/2012; 75(2). DOI:10.1016/j.diagmicrobio.2012.11.004 · 2.57 Impact Factor
Show more