CDC Urges Restraint in Use of Antivirals for H1N1 Infection

Hold your ground when the worried well come into your office this fall demanding prescriptions for Tamiflu and Relenza. US officials emphasize that antiviral drugs should not be used for prevention in healthy persons who have had community exposures. Recently updated CDC recommendations provide further guidance about the appropriate (and limited) settings in which antiviral drugs may be used for chemoprophylaxis during the upcoming flu season.

Reserve antiviral drugs for persons at higher risk for influenza-related complications (eg, patients with neuromuscular disease) who have had contact with a person likely to have been infected with influenza. One option is to provide selected higher-risk patients with a prescription that can be filled at the onset of symptoms after telephone consultation with the primary care provider. As an alternative to chemoprophylaxis, patients at higher risk can be counseled about the early signs and symptoms of influenza and advised to immediately seek medical attention for evaluation and possible early treatment if clinical signs or symptoms develop.

Consider post-exposure antiviral chemoprophylaxis for health care personnel, public health workers, and first responders who have had a recognized, unprotected close contact exposure to a person with confirmed, probable, or suspected 2009 H1N1 or seasonal influenza during that person’s infectious period. However, use of appropriate personal protective equipment and other administrative controls (eg, having health care personnel stay home from work when ill, and triaging for identification of potentially infectious patients) are strongly recommended to reduce the need for post-exposure chemoprophylaxis.

For antiviral chemoprophylaxis of 2009 H1N1 influenza virus infection, either oseltamivir or zanamivir is recommended. The duration of chemoprophylaxis is 10 days after the last known exposure.