influenza%20(pediatric)
INFLUENZA (PEDIATRIC)
Influenza may present as a mild respiratory illness similar to the common cold or it may present without characteristic signs and symptoms.
The main type of influenza virus are types A, B & C virus. Types A&B are the main causes of influenza outbreaks.
Patient may appear flushed and have pain on eye movement. Non-exudative pharyngitis, scattered rales or rhonchi may be present.

Antiviral Agents

  • Option for the control of influenza, but should not be used as a substitute to influenza vaccination

Prophylaxis

  • Antiviral agents (eg Oseltamivir, Zanamivir) may be used to prevent spread of influenza during an influenza outbreak in an institutionalized setting
  • May be used in persons who cannot be vaccinated due to contraindications to vaccine
    • Do not start until influenza epidemic has begun & stop only when epidemic is over
  • May be used in persons at high-risk for complications who have been vaccinated after an outbreak of influenza has begun
    • Give for 2 weeks starting from day of vaccination to give sufficient time for immunity to develop

Treatment

  • When used within 48 hours of symptom onset, antiviral agents may reduce the duration of symptoms
    • Should not be used if there is uncertainty about diagnosis or if bacterial infection cannot be ruled out
    • Administration of antiviral treatment may be considered in very ill or high-risk suspected influenza patients even without confirmed tests if:
      • Currently admitted
      • Categorized as severe, complicated, or with progressive disease
      • At high risk for complications (ie immunocompromised, <2 years of age, with comorbidities)
      • Receiving long-term Aspirin treatment
  • None of the following agents have been shown to be effective in preventing serious influenza-related complications
  • Data is limited concerning effectiveness of the antiviral agents for the treatment of patients at high-risk of serious complications of influenza

Adamantanes

  • Eg Amantadine, Rimantadine
  • Consider local resistance data when prescribing adamantanes for patients with influenza
  • Chemoprophylaxis & treatment against circulating influenza A virus strains using adamantanes are not recommended because of increasing reports of drug resistance
  • Possesses little or no activity against influenza type B virus

Baloxavir marboxil

  • The 1st approved influenza virus-specific enzyme polymerase acidic (PA) protein-targeting drug used for the treatment of acute uncomplicated seasonal influenza in patients ≥12 years old who exhibited symptoms for no more than 48 hours
  • Based on several studies, the therapeutic effect of a single dose of Baloxavir marboxil is comparable to that of the 5-day twice-daily treatment with Oseltamivir

Neuraminidase Inhibitors

  • Eg Oseltamivir, Peramivir, Zanamivir
  • Oral Oseltamivir & inhaled Zanamivir are used for treatment & prophylaxis of infection with influenza A or B viruses
    • Oral Oseltamivir is the antiviral drug of choice for the management of influenza infections in children
      • May be given to premature infants at 3-3.5 mg/kg/dose 12 hrly
    • Inhaled Zanamivir may be used in children ≥7 years old as an alternative treatment for those without any chronic lung disease
  • Recently approved intravenous Peramivir can be used for early treatment of acute uncomplicated influenza in nonhospitalized children ≥2 years of age
  • Studies are still being conducted on the use of intravenous Zanamivir for seasonal influenza but may be considered in newly emergent Oseltamivir- or Peramivir-resistant virus
  • Effects:
    • As treatment: Can reduce duration of uncomplicated influenza A & B illness by approximately 1 day compared with placebo when used within 2 days of illness onset
    • Both drugs are effective, 82% (Oseltamivir) or 84% (Zanamivir), in preventing febrile, laboratory-confirmed influenza illness in otherwise healthy individuals
  • Combination treatment with neuraminidase inhibitors is not recommended
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