ADULT INFLUENZA PRACTICE GUIDELINE 200809

1
ADULT INFLUENZA PRACTICE GUIDELINE 2008/09
NO
Symptomatic Treatment
Symptoms suggestive of acute Influenza
Required symptoms 1. Fever gt 37.8ºC/ 100F
2. Two or more of the following a. Cough b.
Myalgia c. Headache d. Sore throat 3. May
have other symptoms a. Nasal congestion b.
Loss of appetite 4. NO evidence of bacterial
infection
YES
Symptomatic Treatment
Symptoms lt 48 hours
NO

• Patient hospitalized with laboratory-confirmed
  influenza
• Patient with laboratory-confirmed influenza
  pneumonia
• Patient with laboratory-confirmed influenza at
  higher risk for influenza complications
• Patient presenting with laboratory-confirmed
  influenza within 48 hours of symptom
• onset and who wants to decrease transmission of
  influenza to others at higher risk of influenza
• complications

YES

NO
Symptomatic Treatment
Treatment indicated
Treatment Influenza A 1. Preferred agent
Zanamavir (Relenza) Two 5 mg inhalations (10mg)
twice daily (about 12 hours apart) for 5
days DO NOT USE in ASTHMA, COPD , or CHRONIC
RESPIRATORY DISEASE 2. Alternative combination
Oseltamivir (Tamiflu) 75mg twice daily for 5
days PLUS rimantadine 100mg twice daily
Oseltamivir dosage adjustment for renal
impairment Crcl 10-30 ml/min 75mg every other
day Rimantadine In patients with severe
hepatic dysfunction, renal failure (CrCI 10
mL/min) and elderly nursing home patients, a dose
reduction to 100 mg daily is recommended
Influenza B Oseltamivir or Zanamivir SPECIAL
POPULATIONS Pregnancy Oseltamivir, rimantadine
and zanamivir are both Pregnancy Category C
medications, indicating that no clinical studies
have been conducted to assess the safety of these
medications for pregnant women. Because of the
unknown effects of influenza antiviral drugs on
pregnant women and their fetuses, these two drugs
should be used during pregnancy only if the
potential benefit justifies the potential risk to
the embryo or fetus.