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Optimization of Antiviral Prescribing for Influenza

Amesh Adalja
Date posted:
September 14, 2009
Publication type:

J Hosp Med 2009;4(7):E28

John Wiley & Sons
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I read with interest the findings of Wilkes et al.1 regarding the infrequent use of oseltamivir in hospitalized influenza-afflicted children eligible for treatment, despite electronic reminders. I agree with the authors' conclusion that antiviral treatment must be optimized. Wilkes et al.'s study,1 which occurred prior to the era of widespread oseltamivir resistance in H1N1 influenza A isolates,2 also gives further impetus to the need to utilize more sensitive testing for influenza—including rapid determination of subtype to best inform antiviral prescribing decisions. I suspect that their figure of 16.1% compliance with oseltamivir employment in eligible pediatric patients has fallen even lower given that zanamivir is not indicated in children aged <7 years and widespread oseltamivir resistance in H1N1 isolates, coupled with widespread adamantane resistance in H3N2 isolates, has given rise to complicated treatment algorithms3 (which could be simplified if the hemagglutinin subtype was rapidly known, as antiviral resistance has largely tracked with subtype). I believe vigilance in the treatment of seasonal flu must be emphasized because increasing adeptness in the management of seasonal influenza is directly related to adeptness in the management of pandemic influenza.



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