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Antiviral Drugs Should Be Used Cautiously to Fight Flu, U.S. Says
Date:9/8/2009

influenza need prompt treatment with antiviral medicines," she said. "That can be a very important way to reduce the severity of illness. We don't want providers to wait until test results are available, but we want them to start antivirals when you suspect influenza."

The new guidelines also recommend that, when high-risk people have been in contact with someone who has the H1N1 swine flu, doctors should wait to see if flu symptoms develop before starting treatment with antivirals.

"Instead of starting antivirals, we give providers an option we call 'watchful waiting,' and wait and see if fever develops," Schuchat said. "And, when fever or respiratory problems develop, give antivirals then."

Another key to the best use of antivirals in people at risk for complications is to start the drugs as soon as flu symptoms appear, Schuchat said.

She stressed, however, that the new guidelines leave room for judgment and discretion on the part of doctors. "Every patient is different, and we want clinicians to have that opportunity to customize care for each patient," she said.

The recommendations include:

  • Treatment with antivirals is recommended for people at higher risk for complications. These include children younger than 5 years old, adults 65 and older, pregnant women, people with chronic medical or immunosuppressive conditions, such as patients on chemotherapy, and people younger than 19 years of age who are receiving long-term aspirin therapy.
  • Treatment should not wait for lab tests because testing can delay treatment and a negative rapid test for flu does not rule out influenza.
  • For some high-risk patients, doctors may choose to give them antiviral prescriptions that can be filled should symptoms appear.

Schuchat noted that cases of H1N1 swine flu -- now the predominant flu strain in the United States -- have already started to increase, especially in so
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