| Mientras que el uso de antivirales contra la influenza en Estados Unidos se ha incrementado durante la temporada de influenza 2009-10, persisten algunos conceptos errados acerca de estos medicamentos. Más abajo se encuentran listados algunos factores claves a considerar cuando se decida si un paciente necesita ser tratado con medicación antiviral. No es muy tarde despúes de 48 horas Mientras que el tratamiento antiviral es más efectivo cuando es comenzado entre las primeras 48 horas de establecerse la enfermedad, algunos estudios han demostrado que los pacientes hospitalizados se benefician aun cuando el tratamiento sea comenzado con osetalmivir más allá de las 48 horas del comienzo de la misma. Los pacientes externos, particularmente aquellos con factores de riesgo para la forma severa y que no mejoran, también podrían beneficiarse del tratamiento antiviral iniciado más de 48 horas después de aparecer la enfermedad Many 2009 H1N1 Patients Can Benefit from Antiviral Treatment All hospitalized patients with suspected or confirmed 2009 H1N1 should receive antiviral treatment with a neuraminidase inhibitor?either oseltamavir or zanamavir. Moderately ill patients, especially those with risk factors for severe illness, and those who appear to be getting worse can also benefit from neuraminidase inhibitors. No Risk Factors Does Not Mean No Antiviral Treatment While antivirals are recommended for treatment of 2009 H1N1 in patients with risk factors for severe disease, some people without risk factors may also benefit from antivirals. In fact, 40% of children and 20% of adults who end up hospitalized with complications of 2009 H1N1 have no risk factors. Clinical judgment is always an essential part of treatment decisions. Treatment Shouldn?t Wait Until Laboratory Confirmation The earlier antiviral treatment is given, the more effective it is for the patient. If you suspect flu and feel antiviral treatment is warranted, then treat even if the rapid test is negative. Some rapid influenza screening tests may produce false negative results and obtaining more accurate testing results can take more than one day. Capsules Can Ease Oseltamivir Suspension Shortage Commercially produced pediatric oseltamivir suspension is in short supply. However, there are ample supplies of children's oseltamivir capsules, which can be mixed with syrup at home. Pharmacies can also compound adult oseltamivir capsules into a suspension for treatment of ill infants and children. Additional information on compounding can be found at: http://www.cdc.gov/H1N1flu/pharmacist/. References 1. Harper SA et al. Seasonal influenza in adults and children?diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clinical Infectious Diseases 2009 Apr 15;48(8):1003?1032. 2. McGeer A et al. Antiviral therapy and outcomes of influenza requiring hospitalization in Ontario, Canada. Clinical Infectious Diseases 2007 Dec 15;45(12):1568?1575. 3. Lee N et al. Factors associated with early hospital discharge of adult influenza patients. Antiviral Therapy 2007;12(4):501?508. 4. Kaiser L et al. Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Archives of Internal Medicine 2003 Jul 28;163(14):1667?1672. |
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