Tamiflu

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    Tamiflu

    There is a lot of controversy surrounding the use and efficacy of Tamiflu. Below is a brief review of Tamiflu per the CDC.

     

    TL;DR

    -Likely some benefit in elderly (>65y/o), young (<2 y/o), chronically ill, or hospitalized patients

     

    Benefits

    -Shorten duration of fever, illness symptoms

    -May reduce complications from influenza (OM, PNA, respiratory failure)

    -Early use in adult hospitalized patients may reduce death

    -Early use in hospitalized children may reduce duration of hospitalization

     

    Risks

    -Nausea, vomiting, headache

    -Post marketing reports of serious skin reactions and sporadic, transient neuropsychiatric events

     

    Who Should Receive Tamiflu

    -Treatment is recommended as early as possible for patients with confirmed or suspected influenza who:

    1. Hospitalized
    2. Severe complicated or progressive illness
    3. Is at higher risk for complications

    -Can be considered in previously healthy, symptomatic, low risk, outpatients with confirmed or or suspected influenza based on clinical judgement IF treatment can be initiated within 48 hours of symptom onset

     

    Who is High Risk

    -Children <2 y/o

    -Adults >65 y/o

    -Immunosuppression

    -Chronic disease: Cardiovascular, pulmonary, hematologic, metabolic disorders, etc, etc (see CDC link above for full list)

    -Pregnant or postpartum (less than 2wks s/p delivery)

    -American Indians/Alaskan Natives

    -Age <19 y/o who are receiving long term aspirin therapy

    -BMI >40

    -Residents of nursing homes or other chronic care facilities

     

    Diagnostic Testing

    Decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza

    -“…tests do not need to be done on all patients with suspected influenza. For individual patients, tests are most useful when they are likely to yield clinically useful results that will help with diagnosis and treatment decisions”

    -Rapid influenza diagnostic tests provide results “within 15 minutes,” are generally 50-70% sensitive and greater than 90% specific

    -Per microbiology, at Sinai we perform PCR which is both sensitive and specific but takes longer to run

     

    How Widespread is Influenza this Year? 

    -It’s [almost] everywhere

     

     

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