Call me ASAP if you think you have influenza: 2019 - 2020 influenza update

Call your physician as soon as possible if you think you have influenza (cough, sore throat, fever, muscle and body aches) because early treatment of influenza with antiviral drugs, as soon as possible but ideally within 48 hours of the onset of symptoms, can decrease the severity and duration of illness.  Influenza drugs might be called in by phone or an office visit may be needed depending on your situation.  Antiviral drugs are especially recommended for patients at high risk of influenza complications such as those who may have weakened immune systems: pregnant women, patients with chronic lung disease, age over 65, severe obesity (BMI greater than 40), diabetes and other medical problems.   
 
We are in the middle of the 2019 - 2020 influenza season and so far, influenza has spread across the US.  The Centers for Disease Control (CDC) reported on December 14 that there have been at least 3.7 million influenza cases, 32,000 hospitalizations and 1800 deaths.  Prevention and treatment of influenza are thus important issues now.
 
There are four drugs available in the US to treat influenza.  Three of the drugs have a similar mechanism of action and have been available for many years: oseltamivir, an oral drug, peramivir, which must be given intravenously, and zanamivir, an inhaled drug.  Baloxavir is a new drug which has a different mechanism of action than the other three drugs.   https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
 
The most accurate tests to diagnose influenza may take several days for results to become available and rapid flu diagnostic tests (results available in minutes to hours) may be falsely negative in as many as 30% of patients with influenza.  Thus, empirical treatment of outpatients (patients who are not hospitalized) suspected of having influenza on the basis of symptoms, medical history and physical examination, without diagnostic testing, is often justified.
 
Resistance to influenza drugs can be a problem, but so far in the 2019 - 2020 flu season testing of current influenza virus strains has not shown resistance to any of the four available antiviral drugs.   https://www.cdc.gov/flu/weekly/index.htm 
 
The issue of possible antiviral drug resistance raises the issue of whether two antiviral drugs combined might be more effective than one alone.  According to the results of two studies published in the Journal of Infectious Diseases on December 11,  for the treatment of severe influenza two drugs combined were better than one.  https://www.medscapTe.com/viewarticle/922729  However, these studies were in hospitalized patients and one of the drugs is not available in the US.  Also, the studies were not as rigorously controlled as many drug studies.  The study drug which is not currently available in the US is, however, similar to the drug baloxivir which is available in the US.  These results are encouraging, but based on the incomplete data available, the use of two antiviral drugs for influenza is so far likely to be considered only for severely ill hospitalized patients.
 
Finally, influenza vaccination is recommended for anyone who has not already been vaccinated this year.  
Author
Dr. Brian Carty

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