Influenza treatments

Influenza treatment Treatment of uncomplicated acute illness caused by influenza A and B virus in adults and children 7 years of age and older who have been symptomatic for no more than 2 days. 

Influenza treatment- Dose adjustment is recommended for patients with Ccr between 10 and 30 mL/min receiving oseltamivir for treatment of influenza. In these patients, it is recommended that the dose be reduced to 75 mg oseltamivir once daily for 5 days. 

Rimantadine hydrochloride, an alpha-methyl derivative of amantadine (alpha-methyl-l-adamantane methylamine hydrochloride), is more active than amantadine against influenza A viruses in vitro and in laboratory animals. It is an alternative to amantadine for the prevention and treatment of influenza A virus infections in adults and for the prevention of influenza in children. Adverse effects have been considered to be less common with rimantadine (SEDA-8, 143), and it is generally tolerated better than amantadine, because it causes fewer nervous system adverse effects (1). Unfortunately, rimantadine is more costly, which has led many institutions to develop influenza treatment guidelines. Both drugs work by blocking the M2 ion channel, which is needed to affect a pH change that helps to initiate viral uncoating. 

Economic and humanistic outcome evaluations are now made as part of healthcare governance. The information gained from valid outcome measures can be used on a national level to allocate expenditures for treating various sectors of the population (e.g. the elderly, neonates, etc.) or to determine which programs will receive financial resources (e.g. vaccine programs vs. acute influenza treatments). Outcome information can be used to help make decisions regarding the inclusion or exclusion of drugs on formularies. Complete information about the economic, humanistic... 

Holmes, E.H., Devalapally, H., Li, L, Perdue, M.L., and Ostrander, G.K. (2013) Permeability enhancers dramatically increase zanamivir absolute bioavailability in rats implications for an orally bioavailable influenza treatment PLoS One, 8, e61853. doi 10.1371/ journal, pone.0061853. 

Both amantadiae and rknantadiae have been found to reduce the duration of influenza A-iaduced fever and malaise, and to lessen viral shedding. Prophylactic treatment has been recommended for high risk patients (95). It has been suggested that, ia the presence of amantadine, the influenza vims attaches normally to cells, but once iaside the ceU the vims fails to initiate repHcation. Thus amantadine appears to inhibit the initiation of transcription at an early stage between uncoating and viral-specific RNA synthesis (96). 

The use of antibiotics is not recommended, except for the treatment of infectious exacerbations of COPD and other bacterial infections. Influenza vaccines decrease illness and death in COPD patients. Pneumococcal vaccination is also recommended. 

A large and rapidly growing number of clinical trials (phase I and phase II) evaluating the potential of DNA vaccines to treat and prevent a variety of human diseases are currently being performed ( http // clinicaltrials.gov) however, there is yet no licensed DNA vaccine product available for use in humans. The clinical trials include the treatment of various types of cancers (e.g., melanoma, breast, renal, lymphoma, prostate, and pancreas) and also the prevention and therapy of infectious diseases (e.g., HIV/ABDS, malaria, Hepatitis B vims, Influenza vims, and Dengue vims). So far, no principally adverse effects have been reported from these trials. The main challenge for the development of DNA vaccines for use in humans is to improve the rather weak potency. DNA vaccines are already commercially available for veterinary medicine for prevention of West Nile Vims infections in horses and Infectious Hematopoetic Necrosis Vims in Salmon. 

AMANTADINE The nurse administers this drug for the prevention or treatment of respiratory tract illness caused by influenza A virus. Some patients are prescribed this drug to manage extrapyramidal effects caused by drugp used to treat Parkinsonism (See Chaps. 29 and 32). The nurse should protect the capsules from moisture to prevent deterioration. When the drug is administered for symptoms of influenza, it is important to start therapy within 24 to 48 hours after symptoms begin. 

In the clinical setting, zanamivir 12 and oseltamivir 19 are effective in both the prevention and treatment of influenza A and B infection. Benefit in treatment is restricted to patients treated within 48 h of symptom onset (Fleming 2003). Importantly, the effects of drug treatment are a rednction in the severity of illness, and in the incidence of secondary complications. The term of illness is generally rednced between 1 and 2.5 days. The evalnation of zanamivir (Calfee and Hayden 1998 Oxford 2000 Fleming 2003), oseltamivir (Doncette and Aoki 2001 Oxford 2005) and peramivir (Sidwell and Smee 2002) for the treatment, and prophylaxis, of inflnenza virus infection has been reviewed. The reader is directed to these reviews for further details of drug pharmacodynamics and clinical trial data. 

Carter MJ (2007) A rationale for using steroids in the treatment of severe cases of H5N1 avian influenza. J Med Microbiol 56 875-883... 

Ives JA, Carr JA, Mendel DB, Tai CY, Lambkin R, Kelly L, Oxford JS, Hayden FG, Roberts NA (2002) The H274Y mutation in the influenza A/HINI neuraminidase active site following oseltamivir phosphate treatment leave virus severely compromised both in vitro and in vivo. Antiviral Res 55 307-317... 

Smee DE, Bailey KW, Morrison AC, SidweU RW (2002) Combination treatment of influenza A virus infections in ceU culture and in mice with the cyclopentane neuraminidase inhibitor RWJ-270201 and ribavirin. Chemotherapy 48 88-93... 

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