Swine flu: WHO stresses selective use of drugs

Fresh guidelines for managing patients of H1N1 swine flu virus, issued yesterday by the United Nations health body, lay stress on the selective use of anti-viral drugs oseltamivir (tamiflu) and zanamivir to prevent serious illness and deaths and reduce need for hospitalisation.

The patients with uncomplicated symptoms need not be given antiviral treatment as they can fully recover within a week even without any form of medical intervention.

The new briefing note (number 8) released by the World Health Organisation (WHO) maintains that the present pandemic H1N1 virus responds to both oseltamivir and zanamivir (known in medical terminology as neuraminidase inhibitors) but are resistant to second class antivirals. When properly administered, these drugs can significantly reduce the risk of pneumonia (a leading cause of death for both pandemic and seasonal influenza) and the need for hospitalisation.

The updated guidelines represent the consensus reached by an international panel of experts who reviewed all available studies on the safety and effectiveness of these drugs.

These guidelines suggest that treatment with anti-viral drugs should begin immediately in areas where the flu virus is circulating widely in the community; and in other cases only when symptoms begin to deteriorate. Pregnant women and children under the age of 5 years, being at higher risk, should be given anti-viral treatment as soon as possible after the symptoms set in.

Reports from all influenza outbreak sites reveal that the H1N1 virus rapidly becomes the dominant strain in areas where the communities are affected even by seasonal influenza.

The symptoms of deterioration of the disease, which call for use of antiviral drugs, include difficulty in breathing; chest pain; high fever that persists for over 3 days; low blood pressure; bloody or coloured sputum; and body turning blue.

In children, the danger signs include fast or difficult breathing, lack of alertness, difficulty in waking up and little or no desire to play.

The WHO has stated that worldwide, around 40 per cent of the severe cases of H1N1 are occurring in children and adults under the age of 50 years. “Some of these patients experience a sudden and very rapid deterioration in their clinic condition, usually on the day 5 or 6 following the onset of symptoms”, the WHO has pointed out.

Children under the age of 5 years face enhanced risk of relatively more severe illness and should receive prompt medical attention. “Otherwise, healthy children, older than 5 years, need not be given antiviral treatment unless their illness persists or worsens”, the global body maintains.

It has also pointed that globally, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week. “Healthy patients with uncomplicated illness need not be treated with antivirals”, the WHO has suggested.