Journal List > Infect Chemother > v.44(4) > 1035154

Choi, Lee, Lee, Baek, Kim, Kee, Jeong, Kim, Song, Wie, Lee, and Transgovernmental Enterprise for Pandemic Influenza in Korea: Clinical Practice Guideline for Antiviral Treatment and Chemoprophylaxis of Seasonal Influenza

Abstract

Influenza, a highly communicable disease, causes variable epidemics annually and imposes public health problems and socioeconomic burden. In addition to vaccine, antiviral medication has an important role in treatment and prevention of influenza virus infection. As influenza virus is undergoing change of antigenicity and antiviral susceptibility, proper use of antiviral medication is important. This guideline encompasses treatment and chemoprophylaxis with antiviral medications for seasonal influenza based on the current influenza situation in Korea. These recommendations were intended for physicians in all medical specialties who provide care for influenza patients.

Figures and Tables

Figure 1
The weekly proportion of visits for influenza-like illness per 1,000 patients, 2007-2012 seasons [2].
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Table 1
Database and Search Terms for Clinical Guidelines
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Table 2
Characteristics of Selected Clinical Guidelines
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aAssociation of Medical Microbiology and Infectious Diseases Canada.

bCenters for Disease Control and Prevention.

cNational Institute for Health and Clinical Excellence.

dAmerican Academy of Pediatrics.

eAustralian Society for Infectious Diseases.

fGuideline Development Group.

gInfectious Diseases Society of America.

hWorld Health Organization.

Table 3
Recommendation of Strength and Quality of Evidence
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Table 4
Influenza Virus Isolates by Subtype, Reported through the Korean Influenza Surveillance Scheme, KCDC
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Table 5
Antiviral Resistance among Recently Isolated Influenza Viruses
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amantadine and rimantadine

Table 6
Treatment Indications Recommended by Other Clinical Guidelines
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achildren aged <2 years; adults aged ≥65 years; persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury); persons with immunosuppression, including that caused by medications or by HIV infection; women who are pregnant or postpartum (within two weeks after delivery); persons aged <19 years who are receiving long-term aspirin therapy; American Indians/Alaska Natives; persons who are morbidly obese (i.e., body-mass index ≥40); and residents of nursing homes and other chronic-care facilities.

binfants and young children, in particular those <2 years; pregnant women; persons of any age with chronic pulmonary disease (e.g. asthma, COPD); persons of any age with chronic cardiac disease (e.g. congestive cardiac failure); persons with metabolic disorders (e.g. diabetes); persons with chronic renal disease, chronic hepatic disease, certain neurological conditions (including neuromuscular, neurocognitive and seizure disorders, but not including autism spectrum disorders); hemoglobinopathies, or immunosuppression, whether due to primary immunosuppressive conditions, such as HIV infection, or secondary conditions, such as immunosuppressive medication or malignancy; children receiving chronic aspirin therapy; persons aged 65 years and older; obesity.

cPatients who have uncomplicated illness, and are not in a group known to be at higher risk of developing severe or complicated illness, may not need to receive treatment with antivirals. A decision to treat will depend upon clinical judgment and availability of antivirals.

dunvaccinated infants aged 12~24 months; persons with asthma or other chronic pulmonary diseases, such as cystic fibrosis in children or chronic obstructive pulmonary disease in adults; persons with hemodynamically significant cardiac disease; persons who have immunosuppressive disorders or who are receiving immunosuppressive therapy; HIV-infected persons; persons with sickle cell anemia and other hemoglobinopathies; persons with diseases that require long-term aspirin therapy, such as rheumatoid arthritis or Kawasaki disease; persons with chronic renal dysfunction; persons with cancer; persons with chronic metabolic disease, such as diabetes mellitus; persons with neuromuscular disorders, seizure disorders, or cognitive dysfunction that may compromise the handling of respiratory secretions; adults aged >65 years; and residents of any age of nursing homes or other long-term care institutions

epersons with chronic respiratory disease (including asthma and chronic obstructive pulmonary disease), chronic heart disease, chronic renal disease, chronic liver disease, chronic neurological conditions, diabetes mellitus; persons aged >65 years; and persons who might be immunosuppressed.

Table 7
Recommended Dosage of Antiviral Medications for Treatment
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arecommended dosage for one-time dose by child' weight: weight ≤15 kg, 30 mg; 15 kg< weight ≤23 kg, 45 mg; 23 kg< weight ≤40 kg, 60 mg; 40 kg< weight, 75 mg.

bNot approved.

Table 8
Dosing Recommendations for Treatment of Persons with Renal Impairment
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Table 9
Dosing Recommendations for Treatment of Children Aged <1 Year or Premature Infants
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aThe Emergency Use Authorization (EUA) allowed treatment with oseltamivir in children under one year of age during the 2009 H1N1 pandemic only. In cases of higher risk of influenza, oseltamivir can be used, considering potential risk and benefit.

Table 10
Recommended Dosage of Antiviral Medications for Chemoprophylaxis
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aThe Emergency Use Authorization (EUA) allowed chemoprophylaxis with oseltamivirin for children aged 3-11 months during the 2009 H1N1 pandemic only. In cases of higher risk of influenza, oseltamivir of 3mg/Kg/dose can be used once daily, considering potential risk and benefit.

Table 11
Dosing Recommendations for Chemoprophylaxis of Persons with Renal Impairment
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Notes

This study was supported by a grant from the Korea Healthcare technology R&D Project Ministry of Health & Welfare Republic of Korea. (Grant No.: A103001)

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