Antivirals and the flu: know when the time is right

Antiviral medications play a role in treating influenza, but they are not a substitute for vaccination. According to CDC recommendations, all patients at high risk for complications who appear to have influenza should be considered for early antiviral treatment, independent of laboratory confirmation or influenza vaccine status. This approach can help reduce morbidity and mortality, particularly in young children and those who have underlying co-morbidities. Clinical trials and observational data show that early antiviral treatment can shorten the duration of fever and illness symptoms and reduce the risk of complications such as otitis media, pneumonia, and respiratory failure. Although clinical benefit is greatest when treatment is started within 48 hours of influenza illness onset, antiviral treatment may still be beneficial in patients with severe, complicated or progressive illness, hospitalized patients, and pregnant women when initiated after 48 hours of illness onset. Oseltamivir is the only oral formulation currently recommended by the U.S. FDA with activity against both influenza A and B viruses. It can be used for treatment of influenza illness at any age and for chemoprophylaxis in anyone 3 months and older. It is also safe for use in pregnant women. The most common side effects for oseltamivir are nausea and vomiting. Persons at high risk for complications who should receive oseltamivir in the outpatient setting include:

• Pregnant and postpartum women
• Children aged younger than 2 years
• Persons with chronic illness such as asthma, diabetes, sickle cell disease, seizure disorders, etc.
• Persons with neurodevelopmental disorders such as cerebral palsy and intellectual disability
• Persons with immunosuppression
• Children on long-term aspirin therapy