As Flu Activity Rises, CDC Updates Recommendations for Antiviral Medication Use

No one knows better than practicing family physicians that flu activity is spiking in many parts of the country, but what FPs may not know is that the CDC has updated its recommendations for the use of antiviral agents for the treatment and chemoprophylaxis of influenza. The agency also has issued new recommendations regarding the use of these medications specifically in pregnant and postpartum women.

The CDC reported Feb. 11 that 37 states had widespread influenza activity during the week ending Feb. 5, and nine states had regional influenza activity. Visits to physicians for influenza-like illness also increased, with nine of 10 regions reporting activity at or above baseline levels.

The proportion of deaths attributed to pneumonia and influenza was at the epidemic threshold for that week, according to the CDC, and 11 flu-associated pediatric deaths were reported.

The agency published the antiviral recommendations of its Advisory Committee on Immunization Practices in the Jan. 21 Morbidity and Mortality Weekly Report. Six principal changes or updates from the agency's previous recommendations are featured:

In its updated recommendations for antiviral drug use by obstetric health care professionals, the CDC said available data suggest that although oseltamivir and zanamivir are pregnancy category C medications, these medications are not teratogenic.

Furthermore, data from the 2009-10 flu season indicate that pregnant women with confirmed or suspected flu who were treated early with antiviral medications were less likely to be admitted to an intensive care unit and less likely to die. Therefore, said CDC officials, pregnant women with suspected or confirmed influenza should receive antiviral therapy as early in the course of disease as possible.

The agency also made the following recommendations regarding pregnant and postpartum women:

The CDC said that because of the importance of rapid access to antiviral medications, health care professionals who care for pregnant and postpartum women should develop methods to ensure that treatment can be started quickly after symptom onset. The agency recommended that clinicians

Postexposure antiviral chemoprophylaxis can be considered for pregnant and postpartum women who have had close contact with someone likely to have been infectious with influenza, said the CDC.

Zanamivir may be the preferred antiviral for chemoprophylaxis because of its limited systemic absorption, according to the agency. However, because of the risk of respiratory complications that may be associated with zanamivir's inhaled route of administration, oseltamivir is a reasonable alternative for women at risk for respiratory problems. The duration of postexposure chemoprophylaxis is 10 days after the last known exposure.

Women who are given postexposure chemoprophylaxis should be informed that the chemoprophylaxis lowers -- but does not eliminate -- the risk of influenza and that protection stops when the medication is stopped.