Timing of antiviral therapy for seasonal influenza, An Open-Label, Pragmatic, RCT

적응증이라면, 계절 인플루엔자에 대한 항바이러스제 투약은 가능한 빨리 시작해야 합니다. 그 이유는 발병 첫 48시간 이내에 투약할 때 가장 큰 이득이 있기 때문입니다. 그러나 이 시기 이후에 투약하는 것도 이득이 있을 수 있습니다.

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When indicated, antiviral therapy for seasonal influenza should be administered as soon as possible since it confers the greatest benefit within the first 48 hours of illness. However, treatment after this interval can still be beneficial. In a randomized, open-label, European trial, adding oseltamivir to usual care reduced symptom duration among outpatients age one year or older with influenza-like illness compared with placebo, even among those with symptom duration >48 hours.

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For adults ≥65 years old with comorbidities and moderate to severe symptoms, oseltamivir was estimated to reduce symptoms by 2.3 to 3.2 days if started 48 to 72 hours after symptom onset.

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These data support our approach to provide antiviral therapy to patients with severe infection or risk factors for complications(표), regardless of illness duration.

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Groups at high risk for serious influenza complications

Children <5 years, but especially <2 years*

Adults ≥65 years of age

Women who are pregnant or up to two weeks postpartum

Residents of nursing homes and long-term care facilities

Native Americans, including Alaska Natives

People with medical conditions including: Asthma Neurologic and neurodevelopmental conditions (including disorders of the brain, spinal cord, and peripheral nerve and muscle such as cerebral palsy, epilepsy, stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, and spinal cord injury) Chronic lung disease (eg, chronic obstructive pulmonary disease, cystic fibrosis) Heart disease (eg, congenital heart disease, congestive heart failure, coronary artery disease) Blood disorders (eg, sickle cell disease) Endocrine disorders (eg, diabetes mellitus) Kidney disorders Liver disorders Metabolic disorders (eg, inherited metabolic disorders and mitochondrial disorders) Weakened immune system due to disease (eg, HIV, AIDS, cancer) or medication (eg, chemotherapy or radiation therapy, chronic glucocorticoids) Children <19 years of age who are receiving long-term aspirin therapy People with extreme obesity (body mass index [BMI] ≥40)

* In young children, rates of hospitalization and mortality are greatest among those <6 months of age.

Adapted from: Centers for Disease Control and Prevention. People at high risk for flu complications. Available at: www.cdc.gov/flu/about/disease/high_risk.htm (Accessed on August 24, 2019).

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REF. UpToDate 2020.02.02