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Flu Treatment

Q: How is the flu treated?

Dr. Donnica:
The mainstay of flu treatment for most people is in the "tea and sympathy" category.  Bed rest, plenty of fluids, and regular analgesics (e.g. acetaminophen, ibuprofen, aspirin, ketoprofen, naproxen) every 4-6 hrs for fever and pain/achiness.  Children under 12, however, should NOT be given aspirin- this puts them at greatly increased risk for the dangers of Reye's Syndrome.  Treat your other symptoms (sore throat, stuffy nose) with symptomatic relievers such as cough medicines, throat lozenges, nasal decongestants, and antihistamines.  While the evidence has not supported the benefits of Vitamin C, zinc, or echinacea supplements, chicken soup has been proven to have a clinical benefit- it contains the amino acid cysteine, which has a chemical similarity to a prescription drug for respiratory infections.  If you feel really awful, see your physician to discuss other options, some of which are mentioned below.

We used to say that there weren't any prescription drugs to treat flu, because all we had at our disposal were antibacterial antibiotics.  Now there are 4 different anti-viral drugs available.   These first two are in a brand new class of drugs called neuraminidase inhibitors.

  • Relenza ™ (Zanamir)This is a novel new drug only approved in the summer of 1999.  It is an inhaled nasal spray that acts in the lungs, at the site of primary infection.  In addition to treating the influenza type A and B, it successfully prevented flu in four out of five healthy family members who lived with someone already infected with flu.
  • Tamiflu (oseltamivir phosphate)Just approved by the FDA 2 weeks ago, this is the first neuraminidase inhibitor in pill form which is effective against both influenza types A and B.  It was able to reduce the duration and severity of flu symptoms by an average of one day in unvaccinated adults who first agreed to be actively infected with influenza in order to study the drug.  Tamiflu must be given within 40 hours of the first flu symptoms in order to benefit from the medication.  The recommended dosing is twice per day for five days.  Side effects included nausea, vomiting, bronchitis, dizziness, and trouble sleeping.  It is not approved to prevent flu, although a recent study suggested that it might reduce the chance of getting the flu in the first place if unvaccinated people took it daily for the first six weeks of the flu season.
  • This medicine is not yet approved in children, but the preliminary studies are encouraging; not only did it significantly improve their recovery from flu symptoms, but it also reduced the incidence of otitis media (middle ear infection) by 40%.

  • Symmetrel ™ (Amantadine) and Flumadine ™ (Rimantadine): These anti-viral medicines are only useful against Type A influenza. Amantadine is approved for use as a prophylactic and therapeutic agents; its efficacy is about 75% to 90%, similar to that of the influenza vaccine. In clinical studies, Flumadine is as effective as Symmetrel in preventing clinical influenza, yet it has a lower incidence of side effects. These drugs are currently recommended as a short-term (5 to 7 wk) preventive therapy during a presumed outbreak of influenza A for people who did not receive the vaccine or for vaccinated persons (especially in a nursing home) who are becoming ill at a high rate; they may be used for only 2 weeks if the vaccine is given simultaneously.  Household contacts of a patient infected with the virus may also be given preventive therapy, as may staff and patients in hospitals or institutions, in order to prevent an outbreak.

Therapeutically, these medicines can shorten the course of an influenza A infection by 1 or 2 days if given within 48 hours of the onset of illness. The course of therapy is 3-5 days.

Side effects are generally minor and reversible, including:  nervousness, insomnia, dizziness, and difficulty concentrating.  These side effects are more common in the elderly. Side effects generally occur less often with Flumadine than with Symmetrel.

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Created: 10/16/2000  -  Donnica Moore, M.D.

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