CDC tells doctors to ration anti-viral drugs to fight flu

By MISTI CRANE

Not everyone is supposed to get the drugs that can help reduce the effects of H1N1.

The early, rampant and complex flu season is presenting many of us and our doctors with a challenge.

Although there are medications that can shorten the duration and lower the severity of flu, not everyone is supposed to get them.

Tamiflu and Relenza are both antivirals that, if given within 48 hours of illness, can diminish the effects of the new H1N1 flu virus and the seasonal flu.

As flu sickens more people earlier than ever in the season, health officials are telling doctors to save their anti-viral medicine for their sickest and most vulnerable patients.

The reasoning is twofold.

First, there’s not enough to go around; using up anti-virals on people who will easily recover could mean no remedies for the sickest patients.

Second, overuse of Tamiflu and Relenza can prompt viruses to outsmart the treatment and become resistant to the medications.

Drug resistance already has been detected with H1N1, also known as swine flu, and it is well-established with Tamiflu and seasonal flu, said Dr. Larry Schlesinger, director of the division of infectious diseases at the Ohio State University Medical Center.

“I fully agree that we need to be careful, and we need to limit indiscriminate overuse,” he said.

The U.S. Centers for Disease Control and Prevention has told doctors that these groups stand to benefit most from early anti-viral treatment:

U Children younger than 2

U People 65 or older

U Pregnant women

U Those with certain chronic or immunosuppressive conditions

U People younger than 19 who receive long-term aspirin therapy

Gahanna family physician Dr. Randy Wexler said the guidance is realistic and straightforward.

“I have some patients who come who just have a cough. But they don’t feel that bad, so we talk about just riding it out instead,” he said.

But even though CDC guidance doesn’t explicitly call for it, Wexler said he treats teachers and students even if they aren’t at obvious high risk of complications. “I’m still going to treat them, because they’re more likely to spread it.”

One-third of children who have had severe complications from H1N1 have been otherwise healthy children, said Dr. Ryan Vogelgesang, a pediatrician in the Cleveland suburb of Parma and director of the office-based immunization program for the Ohio chapter of the American Academy of Pediatrics.

That makes it difficult to decide which children are at high risk beyond the obvious ones, such as those with asthma, he said.

“I think in reality, when confronted by a patient who has classic flu symptoms and does present within the 48-hour time frame, I think it’s appropriate to treat those patients with Tamiflu,” he said.

Vogelgesang stressed that parents should seek medical attention within 48 hours of onset of illness to maximize the possibility that antivirals will help.

“We are not enormous fans of these drugs at the best of times,” said Dr. Peter Lurie, deputy director of the health-research group at the advocacy group Public Citizen.

The group has been critical of the drugs largely because their effectiveness is limited.

“You wouldn’t want to lose the benefit of the drug for the small number of people who really need it because you’ve been treating people who would do reasonably well without it.”

Steve Wagner, the state’s chief of health preparedness, said he trusts doctors and patients to understand that some will need to forgo treatment to ensure that it will be available for others and will still work when they need it.

mcrane@dispatch.com