Influenza medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
People with the flu are advised to get plenty of rest, drink a lot of liquids, avoid using alcohol and tobacco and, if necessary, take medications such as paracetamol (acetaminophen) to relieve the fever and muscle aches associated with the flu. Children and teenagers with flu symptoms (particularly fever) should avoid taking aspirin during an influenza infection (especially influenza type B) because doing so can lead to Reye's syndrome, a rare but potentially fatal disease of the liver.[1] Since influenza is caused by a virus, antibiotics have no effect on the infection; unless prescribed for secondary infections such as bacterial pneumonia, they may lead to resistant bacteria. Antiviral medication is sometimes effective, but viruses can develop resistance to the standard antiviral drugs.
The two classes of anti-virals are neuraminidase inhibitors and M2 inhibitors (adamantane derivatives). Neuraminidase inhibitors are currently preferred for flu virus infections. The CDC recommended against using M2 inhibitors during the 2005–06 influenza season.[2]
Neuraminidase inhibitors
Antiviral drugs such as oseltamivir (trade name Tamiflu) and zanamivir (trade name Relenza) are neuraminidase inhibitors that are designed to halt the spread of the virus in the body.[3] These drugs are often effective against both influenza A and B.[4] The Cochrane Collaboration reviewed these drugs and concluded that they reduce symptoms and complications.[5] Different strains of influenza virus have differing degrees of resistance against these antivirals and it is impossible to predict what degree of resistance a future pandemic strain might have.[6]
M2 inhibitors (adamantanes)
The antiviral drugs amantadine and rimantadine are designed to block a viral ion channel and prevent the virus from infecting cells. These drugs are sometimes effective against influenza A if given early in the infection, but are always ineffective against influenza B.[4] Measured resistance to amantadine and rimantadine in American isolates of H3N2 has increased to 91% in 2005.[7]
Antiviral Drugs
These treatments are antiviral drugs that affect the virus itself and may be used as either a prophylactic (that is, before infection) or as treatment. In general, antiviral drugs for treatment of influenza must be taken within a few days of the onset of symptoms.
Due to increasing incidence of drug resistance to amantadine and rimantadine in H3N2 during the 2005-2006 flu season in the United States, the CDC recommended the use of oseltamivir for flu prevention and the use of oseltamivir or zanamivir for flu treatment.[8] [9]
Approved
These prescription drugs have been approved by the US Food and Drug Administration as safe and effective.
| Class | Effective Against | Brand Name | Drug Name (INN) | Year Approved | Manufacturer |
|---|---|---|---|---|---|
| M2 inhibitors (adamantane derivatives) |
Influenza A | Symmetrel® | Amantadine | 1976 | Endo Pharmaceuticals |
| Flumadine® | Rimantadine | 1994 | Forest Laboratories | ||
| Neuraminidase inhibitors | Influenza A & B | Relenza® | Zanamivir | 1999 | GlaxoSmithKline |
| Tamiflu® | Oseltamivir | 1999 | Hoffmann-La Roche | ||
| Note: Neuraminidase inhibitors are approved for prophylaxis use in children and adults. | |||||
Experimental
Peramivir is being developed by BioCryst Pharmaceuticals, but has not yet been approved for sale in the United States.[10]
Conventional symptomatic relief
Over the counter medicines may be taken to relieve influenza symptoms, but they do not affect the virus.
| Symptom(s) | OTC Medicine |
|---|---|
| Fever, Aches, Pains, Sinus pressure, Sore throat | Analgesics |
| nasal congestion, sinus pressure | Decongestants |
| sinus pressure, Runny nose, Watery eyes, Cough | Antihistamines |
| cough | Cough suppressant |
| Sore throat | local Anesthetics |
Children and teenagers with flu symptoms (particularly fever) should avoid taking aspirin as taking aspirin in the presence of influenza infection (especially Influenzavirus B) can lead to Reye's syndrome, a rare but potentially fatal disease of the liver.[12]
Unconventional treatment
Homeopathic and other cold and flu remedies that fail to meet the regulatory requirements as drugs that treat disease, or the standards of evidence-based medicine, are sold as nutritional supplements.
They may be based on extracts of living things, but may lack documentation of their safety and effectiveness.
References
- ↑ Glasgow, J (2001). "Reye syndrome — insights on causation and prognosis". Arch Dis Child. 85 (5): 351–3. PMID 11668090. Unknown parameter
|coauthors=ignored (help) - ↑ Centers for Disease Control and Prevention. CDC Recommends against the Use of Amantadine and Rimantadine for the Treatment or Prophylaxis of Influenza in the United States during the 2005–06 Influenza Season. January 14, 2006. Retrieved on 2007-01-01
- ↑ Moscona, A (2005). "Neuraminidase inhibitors for influenza". N Engl J Med. 353 (13): 1363–73. PMID 16192481.
- ↑ 4.0 4.1 Stephenson, I (1999). "Chemotherapeutic control of influenza". J Antimicrob Chemother. 44 (1): 6–10. PMID 10459804. Unknown parameter
|coauthors=ignored (help) - ↑ Jefferson, T. "Neuraminidase inhibitors for preventing and treating influenza in healthy adults". Cochrane Database Syst Rev. 3: CD001265. doi:10.1002/14651858.CD001265.pub2. PMID 16855962. Unknown parameter
|coauthors=ignored (help) - ↑ Webster, Robert G. (2006). "H5N1 Influenza — Continuing Evolution and Spread". N Engl J Med. 355 (21): 2174–77. PMID 16192481.
- ↑ "High levels of adamantane resistance among influenza A (H3N2) viruses and interim guidelines for use of antiviral agents — United States, 2005–06 influenza season". MMWR Morb Mortal Wkly Rep. 55 (2): 44–6. 2006. PMID 16424859.
- ↑
Smith, Nicole M. (2006-07-28). "Prevention and Control of Influenza". Morbidity and Mortality Weekly Report. Centers for Disease Control and Prevention. Retrieved 2007-05-25. Unknown parameter
|coauthors=ignored (help) - ↑ Altman, Lawrence K. (2006-01-15). "This Season's Flu Virus Is Resistant to 2 Standard Drugs". New York Times. Retrieved 2007-05-25.
- ↑ "Peramivir Fact Sheet" (pdf). BioCryst Pharmaceuticals Inc. Retrieved 2007-05-25.
- ↑ "Cold and Flu Guidelines: Influenza". American Lung Association. Retrieved 2007-09-16.
- ↑ Molotsky, Irvin (1986-02-15). "Consumer Saturday - Warning on Flu and Aspirin". New York Times. Retrieved 2007-05-25.