While asserting that clinical judgment is always an important part of treatment decisions, the CDC has updated its advice for health-care providers on the use of antiviral agents for the prevention and treatment of flu, including 2009 H1N1 influenza infection.

In the September 8 update, the CDC set forth several recommendations, including but not limited to the following:

  • People who are not at heightened risk for complications stemming from flu infection or who are not sick enough from the flu to require hospitalization generally don’t need antiviral agents for prevention or treatment.
  • Treatment with oseltamivir (Tamiflu) or zanamivir (Relenza) is recommended for anybody with suspected or confirmed flu requiring hospitalization.
  • Treatment with oseltamivir or zanamivir generally is recommended for people with suspected or confirmed flu if they are at heightened risk for complications, including children under age five years, adults age 65 years and older, pregnant women, individuals with certain chronic medical or immunosuppressive conditions, and people younger than age 19 years who are undergoing long-term aspirin therapy. (Groups at higher risk for complications of 2009 H1N1 influenza are similar to those at higher risk for complications from seasonal flu.)
  • When required, treatment should be started as early as possible; if it’s initiated within 48 hours of illness onset it’s more likely to provide benefit.
  • A negative rapid test for influenza does not rule out the infection; therefore, treatment should not wait for laboratory confirmation of influenza.

The full CDC guidance is available online.

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