1/11/10

1/14/10

1/16/10

Alisa Alker

Treatment: who, what, when?

Who should be treated

CDC recommendations of who should be treated

illness requiring hospitalization

progressive, severe illness, regardless of previous health status

risk factors for severe illness, such as chronic pulmonary disease, CV disease, malignancy, chronic renal insufficiency, chronic liver disease, DM, and hemoglobinopathies such as sickle cell, HIV or other immunosuppressive states, rheumatological disorders, any individual who might have problems handling their own secretions, and obesity*

Consider treating if a mild disease in someone with no risk factors in whom the symptoms started <48 hours ago

Treatment choices

neuraminidase inhibtors

oseltamivir- 75 mg po BID

zanamivir- inhaled

peramivir- IV (investigational)

rimantadine and amantadine

ECMO

retrospective analysis of patients with confirmed H1N1 placed on ECMO (n=61) and with mechanical ventilation (n=133)

pts on ECMO tended to be younger, more hypoxic, and more sick

mortality: ECMO 23% mech. vent. 14%

Influenza in NC

http://www.epi.state.nc.us/epi/gcdc/flu0910.html

References1. Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA. 2009 Nov

4;302(17):1888-1895.

2. Domínguez-Cherit G, Lapinsky SE, Macias AE, Pinto R, Espinosa-Perez L, de la Torre A, et al. Critically Ill patients with 2009 influenza A(H1N1) in Mexico. JAMA. 2009 Nov 4;302(17):1880-1887.

3. Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, et al. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA. 2009 Nov 4;302(17):1872-1879.

4. Lee C, Lee J. Dynamics of clinical symptoms in patients with pandemic influenza A (H1N1). Clinical Microbiology and Infection. 2010 4;16(4):389-390.

5. Louie JK, Acosta M, Winter K, Jean C, Gavali S, Schechter R, et al. Factors Associated With Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California. JAMA. 2009 Nov 4;302(17):1896-1902.

6. CDC H1N1 Flu | Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season [Internet]. [cited 2010 Mar 17];Available from: http://www.cdc.gov.libproxy.lib.unc.edu/H1N1flu/recommendations.htm