INDICATIONS FOR CHEMOPROPHYLAXIS — Chemoprophylaxis with antiviral drugs is not recommended for healthy persons exposed to influenza. It can be considered for unvaccinated persons (or those unlikely to respond to vaccination) at high risk for complications of the disease, for unvaccinated healthcare workers who come into close contact with a person with confirmed or suspected influenza during the infectious period (24 hours before onset of fever to 24 hours after its resolution), and to help control outbreaks in nursing homes.10 When indicated, chemoprophylaxis should be started within 48 hours of exposure to the disease. Some experts would advise using twice-daily therapeutic doses instead of once-daily prophylactic doses for post-exposure prophylaxis in highly immunocompromised hosts.
PREGNANCY — Pregnant women with influenza are at high risk for complications, including death. Even though oseltamivir and zanamivir are classified as category C (risk cannot be ruled out) for use during pregnancy, prompt treatment with one of these antiviral medications is recommended for this high-risk population.11,12 Clinical experience with use in pregnancy has been most extensive with oseltamivir.
ADAMANTANES — All influenza A isolates tested by the CDC this season have been resistant to the adamantanes amantadine and rimantadine (Flumadine, and others). These drugs have never been active against influenza B. They are not currently recommended for prophylaxis or treatment of influenza.
CONCLUSION — A neuraminidase inhibitor, either oseltamivir (Tamiflu) or zanamivir (Relenza), remains the drug of choice for treatment of patients with influenza who are at high risk for complications of the disease, and for anyone hospitalized with presumed influenza. Oseltamivir is preferred for treatment of pregnant women. Healthy persons generally do not require antiviral prophylaxis or treatment for influenza.
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