Treatment Treatment Recommendations Recommendations

of swine fluof swine flu ByBy

Nesrien Mohammed Shalabi

Ass. Prof of Thoracic Medicine

5/5/2009

The CDC recommendsThe CDC recommends

Patients should seek immediate medical care.Patients should seek immediate medical care.

Self isolation in their home. Self isolation in their home.

Patients must use face mask.Patients must use face mask.

Other household members should be given Other household members should be given infection control instruction.infection control instruction.

Supportive treatment including:- bed rest, Supportive treatment including:- bed rest, increased fluid consumption, cough increased fluid consumption, cough suppressants, antipyretics and analgesics.suppressants, antipyretics and analgesics.

Hospitalized PatientsHospitalized PatientsPlace patients in a single patient room with door Place patients in a single patient room with door

kept closed.kept closed.

An airborne-infection isolation room can be An airborne-infection isolation room can be used.used.

Suctioning, bronchoscopy, or intubation.Suctioning, bronchoscopy, or intubation.

Patient should wear a surgical mask when Patient should wear a surgical mask when outside their room.outside their room.

Encourage patients to wash their hand Encourage patients to wash their hand frequently.frequently.

Severely ill patientsSeverely ill patients

Signs of severe disease include:-Signs of severe disease include:-

Cyanosis, dehydration, altered mental statusCyanosis, dehydration, altered mental status

Apnea, tachypnea, dyspnea.Apnea, tachypnea, dyspnea.

Need Mechanical ventilationNeed Mechanical ventilation

Antiviral DrugsAntiviral Drugs EmpiricEmpiric Should be considered for:-Should be considered for:- Confirmed, probable or suspected cases of swine Confirmed, probable or suspected cases of swine

influenza.influenza.

Treatment of hospitalized patients and patients at higher Treatment of hospitalized patients and patients at higher risk for influenza complication.risk for influenza complication.

Initiation of antiviral agents within 48 hours of Initiation of antiviral agents within 48 hours of symptom onset the recommended duration of symptom onset the recommended duration of treatment is 5 days.treatment is 5 days.

Prophylaxis antiviral agentsProphylaxis antiviral agentsShould be considered in the following individuals (pre-Should be considered in the following individuals (pre-

exposure or post-exposure):-exposure or post-exposure):-

Close household contacts of a confirmed or suspected case who are Close household contacts of a confirmed or suspected case who are at risk.at risk.

School children at high risk of complications or have been in close School children at high risk of complications or have been in close contact with confirmed or suspected case.contact with confirmed or suspected case.

Travelers to Mexico who are at high risk for Travelers to Mexico who are at high risk for complications.complications.

Health care providers or public health workers.Health care providers or public health workers.

Pre exposure prophylaxisPre exposure prophylaxis

Any health care provider who is at Any health care provider who is at high risk for complication.high risk for complication.

Individuals not considered to be at Individuals not considered to be at high risk but who are nonetheless high risk but who are nonetheless traveling to Mexico or working in traveling to Mexico or working in areas with confirmed cases.areas with confirmed cases.

Antiviral DrugsAntiviral DrugsThere are four influenza antiviral drugs:-There are four influenza antiviral drugs:-Oseltamivir (brand name Tamiflu)Oseltamivir (brand name Tamiflu)Zanamivir (brand name Relenza)Zanamivir (brand name Relenza)Amantadine (brand name Lysovir)Amantadine (brand name Lysovir)Rimantadine (brand name Symmetrel)Rimantadine (brand name Symmetrel)

The swine influenza A(H1N1) viruses in The swine influenza A(H1N1) viruses in humanshumans

Resistant to amantadine and rimantadine.Resistant to amantadine and rimantadine.Sensitive to oseltamivir and zanamivir.Sensitive to oseltamivir and zanamivir.

Benefits of Benefits of Antiviral DrugsAntiviral Drugs

Antiviral can make illness milder with Antiviral can make illness milder with faster improvement.faster improvement.

Prevent serious influenza complicationsPrevent serious influenza complications

Oseltamivir (Tamiflue)Oseltamivir (Tamiflue)It inhibits neuraminidase which is a glycoprotein on the It inhibits neuraminidase which is a glycoprotein on the surface of influenza virus that destroys an infected cell’s surface of influenza virus that destroys an infected cell’s receptor viral hemagglutinin.receptor viral hemagglutinin.

FormsForms

Oral capsules Oral capsules 30mg, 45mg and 75mg.30mg, 45mg and 75mg.

Powder for suspension Powder for suspension that contain 12mg/ml after that contain 12mg/ml after reconstitution.reconstitution.

Adult doseAdult dose

Treatment of acute illness 75 mg /12 hours for 5 daysTreatment of acute illness 75 mg /12 hours for 5 days

Prophylaxis 75 mg once daily for 10 days.Prophylaxis 75 mg once daily for 10 days.

Zanamivir (Relenza)Zanamivir (Relenza)

FormsFormsPowder form for inhalation via Diskhaler. The circular Powder form for inhalation via Diskhaler. The circular

foil discs contain 5mg blisters. Disks contain 4 foil discs contain 5mg blisters. Disks contain 4 blisters.blisters.

Adult doseAdult doseTreatment of acute illness: 10mg twice daily for 10 Treatment of acute illness: 10mg twice daily for 10

days.days.Prophylaxis of household contact: 10mg once daily for Prophylaxis of household contact: 10mg once daily for

10 days.10 days.Prophylaxis of community contact: 10mg once daily for Prophylaxis of community contact: 10mg once daily for

28 days.28 days.