Novel influenza A, H1N1 - Acute
Rahul Soman, M. Pharm
Definition
An influenza-like illness caused by a new influenza virus called novel H1N1 (formerly called "swine flu"), that is contagious and is spreading from human to human
Medical History
* Close contact to persons infected with swine-origin influenza A (H1N1) virus
* Close contact with infected swine
Findings
* Fever
* Cough
* Pain in throat
* Nasal congestion
* Nasal discharge
* Dyspnea - Acute
* Fatigue
* Loss of appetite
* Myalgia
* Headache
* Nausea and vomiting - Acute
* Diarrhea
* Decreased skin turgor
* Altered mental status
* Irritability
* Apnea
* Cyanosis
* Tachypnea
Tests
Initial testing for identification of influenza A, B, H1, and H3 status at a State Health Department laboratory
* Polymerase chain reaction analysis
Suspected novel influenza A (H1N1) virus infection
* PCR test for swine influenza A: A positive real time reverse transcription-polymerase chain reaction result indicates presumptive infection with novel influenza A (H1N1) virus .
Suspected novel influenza A (H1N1)
* Rapid influenza test: A positive rapid influenza detection test cannot distinguish between influenza A virus subtypes , and a negative result does not exclude influenza virus infection .
Differential Diagnosis
* Influenza due to Influenza A virus
* Influenza due to Influenza virus, type B
* Influenza due to Influenza virus, type C
* Respiratory syncytial virus infection
* Bronchitis, acute - Acute
* Common cold
Treatment
Drug Therapy
Novel influenza A (H1N1) virus infection
OSELTAMIVIR PHOSPHATE
Adults: 75 mg orally twice daily for 5 days
Adults (creatinine clearance 10 to 30 mL/min): 75 mg orally once daily for 5 days
Pediatrics, weight-based dosing preferred (<12 months): 3 mg/kg orally twice daily for 5 days
Pediatrics (?12 months and ?15 kg): 30 mg orally twice daily for 5 days
Pediatrics (?12 months and >15 kg to 23 kg): 45 mg orally twice daily for 5 days
Pediatrics (?12 months and >23 kg to 40 kg): 60 mg orally twice daily for 5 days
Pediatrics (?12 months and >40): 75 mg orally twice daily for 5 days
Pediatrics, age-based dosing if weight unknown (full-term infants <3 months): 12 mg orally twice daily for 5 days
Pediatrics, age-based dosing if weight unknown (full-term infants 3 to 5 months): 20 mg orally twice daily for 5 days
Pediatrics age-based dosing if weight unknown (full-term infants 6 to 11 months): 25 mg orally twice daily for 5 days
ZANAMIVIR
Adults: 10 mg (2 oral inhalations) twice daily for 5 days
Pediatrics (?7 years): 10 mg (2 oral inhalations) twice daily for 5 days
Novel influenza A (H1N1) virus infection in hospitalized adults and children who meet criteria for emergency use authorization
PERAMIVIR
Adults: 600 mg IV over 30 min once daily for 5 to 10 days
Pediatrics (birth to 30 days): 6 mg/kg IV over 60 min once daily for 5 to 10 days (maximum 600 mg daily)
Pediatrics (31 days to 90 days): 8 mg/kg IV over 60 min once daily for 5 to 10 days (maximum 600 mg daily)
Pediatrics (91 days to 180 days): 10 mg/kg IV over 60 min once daily for 5 to 10 days (maximum 600 mg daily)
Pediatrics (181 days to 5 years): 12 mg/kg IV over 60 min once daily for 5 to 10 days (maximum 600 mg daily)
Pediatrics (6 to 17 years): 10 mg/kg IV over 60 min once daily for 5 to 10 days (maximum 600 mg daily)
Fever
ACETAMINOPHEN (Related toxicological information in ACETAMINOPHEN-ACUTE, ACETAMINOPHEN-REPEATED SUPRATHERAPEUTIC)
Adults: 650 mg (2 regular-strength tablets) orally every 4 to 6 hours (maximum, 12 tablets in 24 hours) or 2 suppositories (325 mg/suppository) every 4 to 6 hours (maximum, 12 suppositories in 24 hours)
Pediatrics (2 to 3 years): (2 to 3 years; 24 to 35 pounds) 5 mL liquid (160 mg/5 mL) orally every 4 hours (maximum 5 doses in 24 hours) or (3 years) 1 pediatric suppository (120 mg/suppository) every 4 to 6 hours (maximum, 6 suppositories in 24 hours)
Pediatrics (4 to 5 years; 36 to 47 pounds): 7.5 mL liquid (160 mg/5 mL) orally every 4 hours (maximum 5 doses in 24 hours) or 1 pediatric suppository (120 mg/suppository) every 4 to 6 hours (maximum, 6 suppositories in 24 hours)
Pediatrics (6 to 11 years): 325 mg (1 regular-strength tablet) orally every 4 to 6 hours (maximum, 5 tablets in 24 hours) or 1 suppository (325 mg/suppository) every 4 to 6 hours (maximum, 6 suppositories in 24 hours) or (6 to 8 years; 48 to 59 pounds) 10 mL liquid (160 mg/5 mL) orally every 4 hours (maximum 5 doses in 24 hours) or (9 to 10 years; 60 to 71 pounds) 12.5 mL liquid (160 mg/5 mL) orally every 4 hours (maximum 5 doses in 24 hours) or (11 years; 72 to 95 pounds) 15 mL liquid (160 mg/5 mL) orally every 4 hours (maximum 5 doses in 24 hours)
Pediatrics (12 years and older): 650 mg (2 regular-strength tablets) orally every 4 to 6 hours (maximum, 12 tablets in 24 hours) or 2 suppositories (325 mg/suppository) every 4 to 6 hours (maximum, 12 suppositories in 24 hours)
IBUPROFEN (Related toxicological information in IBUPROFEN)
Adults: 1 or 2 tablets (200 mg/tablet) orally every 4 to 6 hours (maximum, 6 tablets in 24 hours)
Pediatrics (6 months to 12 years): 5 mg/kg oral suspension (100 mg/5 mL) for baseline temperature <102.5°F; 10 mg/kg for baseline temperature ?102.5°F (maximum daily dose, 40 mg/kg)
NAPROXEN (Related toxicological information in NAPROXEN)
Prevention of pneumococcal pneumonia in persons ?65 years, high-risk persons aged 2 to 64 years, persons with asthma, and current smokers
PNEUMOCOCCAL VACCINE POLYVALENT
Adults (primary vaccination): 0.5 mL IM x one dose given to all adults 65 years of age and older
Adults (revaccination): 0.5 mL IM x one dose given to all adults 65 years of age and older who were vaccinated before the age of 65 and at least 5 years prior
Adults (at high-risk): 0.5 mL IM x one or 2 doses, at least 5 years apart, for adults less than 65 years of age who have medical indications for vaccination or are part of high risk populations
Pediatrics (2 to 18 years): 0.5 mL IM or subQ as a single dose; may be repeated once after 5 years in selected cases
Procedural Therapy
Suspected, probable, or known novel influenza A (H1N1) virus infection in a healthcare setting
* Infection control procedure: Standard and contact precautions plus eye protection should be used by all personnel entering the patient's room for 7 days after illness onset or until symptoms have resolved, whichever is longer .
Non-Procedural Therapy
Novel influenza A, H1N1
* Home Care of a Patient with Novel Influenza A (H1N1) Virus Infection
* Facemask and Respirator Recommendations in Occupational (Non-Healthcare) Settings
* Facemask and Respirator Recommendations in Community Settings
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