Treatment

Treatment options for influenza are very limited.

The antiviral Tamiflu is thought to be beneficial if given soon after infection, within 48 hours. Benefit after this time is appears to be limited, but there are insufficient studies for a hard and fast rule. Some studies indicate that twice as much Tamiflu as is typically prescribed for "regular" flu is necessary to treat H5N1 influenza. Most countries, including the United States do not have enough Tamiflu to treat all of the cases that will likely occur during the current new H1N1 pandemic. Some Tamiflu-resistant isolates of the new H1N1 have been identified (see Tamiflu Resistant Strains of Pandemic H1N1 for more details). However, at this time, most cases of H1N1 appear to be susceptible to Tamiflu treatment.

Relenza works in a similar to Tamiflu but uses an inhaler to deliver the medicine.

An experimental antiviral drug called Permavir was recently approved under emergency authorization from the FDA. This is an intravenous drug that can be given in the hospital to people suffering severe symptoms.

Many of the pandemic H1N1 virus and H5N1 virus survivors have spent long periods of time receiving advanced medical care. Some have been on ventilators. During the current pandemic, this level of care is already strained and become unavailable because there are more patients that available equipment and trained personnel. Rules are being discussed for triage, but in practice, decisions about who gets advanced care and who is given palliative care will likely to be made by medical personnel on the scene.

Given that there is insufficient Tamiflu, ventilators, ECMO and health care workers to treat the ill, most of those infected in the current pandemic will likely not receive any care in a hospital. They may receive some level of care in impromtu flu hospitals, tents, schools or hotels, but most likely will never leave their homes. Thus, family members are providing most of the care that patients are receiving in the current pandemic.

References

Treatment (Antiviral Drugs)
CDC

Quick Facts for Clinicians on Antiviral Treatments for 2009 H1N1
CDC

Antiviral Treatment Options, including Intravenous Peramivir, for Treatment of Influenza in Hospitalized Patients for the 2009-2010 Season
CDC

Emergency Use Authorization of Peramivir IV
CDC

Ison (2009) Safety and Efficacy of Multiple-Day Treatment with Intravenous Peramivir or Oral Oseltamivir in Hospitalized Adults with Acute Influenza. XI International Symposium on Respiratory Viral Infections.

Englund et al. (2009) Oseltamivir-Resistant Novel Influenza A (H1N1) Virus Infection in Two Immunosuppressed Patients --- Seattle, Washington, 2009. MMWR. 58: 893-896.

Garrison et al. (2009) Oseltamivir-Resistant 2009 Pandemic Influenza A (H1N1) Virus Infection in Two Summer Campers Receiving Prophylaxis --- North Carolina, 2009. MMWR.58: 969-972.

Firstenberg et al. (2009) Extracorporeal Membrane Oxygenation for Pandemic (H1N1) 2009. Emerg Infect Dis.

Clinician Outreach and Communication Activity (COCA) Conference Call. (November 4, 2009) Pandemic Influenza A (H1N1) in Critically Ill Patients.

News

Who gets ventilators?
MSNBC