Selecting a Treatment Regimen
Table 5. Conditions Placing Patients at High Risk of
Complications From Influenza: Antiviral Therapy
Should Be Considereda
• Infants <24 months of age
• Asthma or other chronic pulmonary diseases, such as cystic fibrosis in children or
chronic obstructive pulmonary disease in adults
• Hemodynamically significant cardiac disease
• Immunosuppressive disorders or therapy
• Human immunodeficiency virus infection
• Sickle cell anemia and other hemoglobinopathies
• Diseases requiring long-term aspirin therapy, such as rheumatoid arthritis or
Kawasaki disease
• Chronic renal dysfunction
• Cancer
• Chronic metabolic disease, such as diabetes mellitus
• Pregnancy
• Neuromuscular disorders, seizure disorders, or cognitive dysfunction that may
compromise the handling of respiratory secretions
• Adults ≥65 years of age
• Residents of any age of nursing homes or other long-term care institutions
• Persons who are morbidly obese (ie, body mass index ≥40)
a
Although sufficient data do not exist to precisely define the extent of increased risk of influenza in
these different groups of patients, there are data to suggest the highest risks of both mortality
and serious morbidity (eg, hospitalization) are in severely immunocompromised patients (eg,
hematopoietic stem cell transplant patients) and in very elderly (>85 years of age) residents of
nursing homes. Infants <24 months of age also have high hospitalization rates but lower case
fatality rates than these groups.
Antivirals for Treatment (all A-II)
ÎÎAntiviral selection should be based on current community- and
patient-specific susceptibility patterns.
ÎÎAs of August 2011, circulating strains of seasonal influenza A
(H3N2) and influenza A (H1N1)—including those related to 2009
pandemic H1N1—should be treated with oseltamivir or zanamivir.
The adamantanes (amantadine and rimantidine) should not be used
because of high rates of resistance.
ÎÎInfection with an influenza B virus should be treated only with
oseltamivir or zanamivir.
ÎÎRefer to Table 6 for detailed information on antiviral regimens in
appropriate age groups.
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