Treatment Recommendations of swine flu By Nesrien Mohammed Shalabi Ass. Prof of Thoracic Medicine 5/5/2009

The CDC recommends Patients should seek immediate medical care. Self isolation in their home. Patients must use face mask. Other household members should be given infection control instruction. Supportive treatment including:- bed rest, increased fluid consumption, cough suppressants, antipyretics and analgesics.

Hospitalized Patients Place patients in a single patient room with door kept closed. An airborne-infection isolation room can be used. Suctioning, bronchoscopy, or intubation. Patient should wear a surgical mask when outside their room. Encourage patients to wash their hand frequently.

Severely ill patients Signs of severe disease include:- Cyanosis, dehydration, altered mental status Apnea, tachypnea, dyspnea. Need Mechanical ventilation

Antiviral Drugs Empiric Should be considered for:- Confirmed, probable or suspected cases of swine influenza. Treatment of hospitalized patients and patients at higher risk for influenza complication. Initiation of antiviral agents within 48 hours of symptom onset the recommended duration of treatment is 5 days.

Prophylaxis antiviral agents Should be considered in the following individuals (pre-exposure or post-exposure):- Close household contacts of a confirmed or suspected case who are at risk. School children at high risk of complications or have been in close contact with confirmed or suspected case. Travelers to Mexico who are at high risk for complications. Health care providers or public health workers.

Pre exposure prophylaxis Any health care provider who is at high risk for complication. Individuals not considered to be at high risk but who are nonetheless traveling to Mexico or working in areas with confirmed cases.

Antiviral Drugs There are four influenza antiviral drugs:- Oseltamivir (brand name Tamiflu) Zanamivir (brand name Relenza) Amantadine (brand name Lysovir) Rimantadine (brand name Symmetrel) The swine influenza A(H1N1) viruses in humans Resistant to amantadine and rimantadine. Sensitive to oseltamivir and zanamivir.

Benefits of Antiviral Drugs Benefits of Antiviral Drugs Antiviral can make illness milder with faster improvement. Prevent serious influenza complications

Oseltamivir (Tamiflue) It inhibits neuraminidase which is a glycoprotein on the surface of influenza virus that destroys an infected cell’s receptor viral hemagglutinin. Forms Oral capsules 30mg, 45mg and 75mg. Powder for suspension that contain 12mg/ml after reconstitution. Adult dose Treatment of acute illness 75 mg /12 hours for 5 days Prophylaxis 75 mg once daily for 10 days.

Zanamivir (Relenza) Forms Powder form for inhalation via Diskhaler. The circular foil discs contain 5mg blisters. Disks contain 4 blisters. Adult dose Treatment of acute illness: 10mg twice daily for 10 days. Prophylaxis of household contact: 10mg once daily for 10 days. Prophylaxis of community contact: 10mg once daily for 28 days.