Monday, 2 February 2015

IMA FLU update on anti viral drug oseltamivir : Mild to moderate flu requires no anti viral drugs

People do not die of swine flu but of swine flu pneumonia and other complications. So no breathlessness no panic, said Padma Shri Awardees Dr A Marthanda Pillai National President and Dr K K Aggarwal Honorary Secretary General IMA in a joint statement.
Flue means fever with muscle pains, cough and cold. In patients with mild to moderate disease in whom the symptoms aren't going to last long anti viral drugs and tests are not needed.

"But at this time of year, if someone has fever of 103°F with massive muscle aches and a cough its is swine flu unless proved otherwise. It is justifiable to start swine flu anti viral drug within 48 hours of onset of symptoms even without going for the test. But if one has low-grade fever and feels just a bit poorly, no drug or test may be prescribed " added Dr Aggarwal.

" Remember if you need to give then give antiviral agents as early as possible. If you start the drug within 48 hours of onset of symptoms, you will see an improvement of about 30 hours in time to getting better, but if you start the drug after 48 hours, there is no discernible benefit" said Dr Aggarwal.
IMA guidelines said that " however in hospitalized patients treating these patients more than 48 hours after onset of symptoms still provides some benefit".

As per CDC and IMAS guidelines, for someone who is sick enough to be in the hospital and perhaps in the ICU, using the 48-hour cut-off for treatment is not appropriate. However, it is still important to start treatment as early as possible, because 24 hours results are better than 48 hours and 48 hours results are better than 96 hours in terms of reduction in ICU admission or death.

About antibiotics IMA guidelines said that out of 99 influenza cases less than one will get bacterial super infection leading to pneumonia. It is true that flu predisposes to bacterial pneumonia but giving an antibiotic will not prevent it. And if you treat all 99 of them with antibiotics there will be more complications like rashes, diarrhea and drug resistance than benefits.

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