Thursday, December 10, 2009

Influenza in infants - oseltamivir and a daycare

Well, it seems as throughout the progression of the flu season, the number of cases have been decreasing, however, the flu has taken its toll in terms of mortality, so we should be very careful and not dismiss the safety measures wisely implemented. Follow the CDC H1N1 Flu updates here.

I wish I would be able to convince many parents who adamantly refuses the influenza H1N1 vaccine given the extreme misinformation provided by the media "based" on "non-evidence-based" resources. It is frustrating as a physician it is my main interest to enhance and ensure the well being of the human-kind. But for the most part, the majority of parents have been very well compliant with the recommendations. It should be recognized the fact that immunizations are perhaps, the best discovery of the last century, and hopefully the truth will overcome the fear toward immunizations.

Today, I had a 6 months old little boy admitted with URI symptoms, with very prominent clear rinorrhea, nasal congestion, cough and concerns for bronchiolitis. As soon as he had his nose cleared with bulb syringe suctioning, his symptoms improved dramatically and did not require oxygen. As part of the admission we obtained a Respiratory Viral Panel (an example of what it detects is here). The baby had positive Influenza A, and by definition, on this season, you consider it as H1N1. His family got the influenza vaccine; his parents are extremely pleasant, but the fact is that the baby started going to daycare last week.

Fortunately for him his chest roentgenogram is normal and is not requiring oxygen, however, the question brought to the table was: it is safe to start him on antivirals?

The data on safety and dosing of oseltamivir in infants is very limited, and if used, a careful monitoring for adverse events should be pursued. FDA recommends against routine prophylactic use in infants younger that 3 months of age. Recently (October 30, 2009), the FDA released a statement about Emergency use of Tamiflu in Infants less than 1 year of age.


The recommended treatment dose for infants younger than 12 months of age is 3 mg/kg/dose twice a day. However, as it will likely happen, if weight is unknown, a dose based on age can be used: birth to 2 mo, 12 mg (1 mL) BID; 3-5 mo, 20 mg (1.6 mL) BID; 6-11 mo, 25 mg (2 mL) BID.

The recommended prophylactic dose for infants 3 mo to 1 year old is 3 mg/kg/dose once daily. For infants younger than 3 months it is not recommended.

Of note, the FDA makes it very clear that the weight-based dosing recommendations are not intended for premature infants, as given their immature renal function, they can have slower clearance and offer the potential for toxicity.

So, we started him on oseltamivir, and we had as well an immediate concern for the parents. So we gave them a prescription for prophylactic oseltamivir use. Hopefully they won't develop the symptoms. They are immunized and hopefully in the case that the flu shows up, it will be as mild as it can be.

What about the other kids in the daycare? should they receive prophylaxis? what is my role as a hospitalist? - we essentially let the parents inform the daycare about the case and the other children's parents can discuss with their pediatricians; most likely they'll get prophylaxis.

Follow me on Twitter for daily up-to-date cutting edge medical information!

Follow medpedshosp on Twitter

Twitter

My Blog List

My slides at Scribd

You can access the the presentations I have given at the Department of Hospital Medicine as well as the Children's Hospital at the Cleveland Clinic, as well as lectures given to the medical students at the Cleveland Clinic Lerner College of Medicine. http://www.scribd.com/medpedshospitalist

Slideshows by User: mauron

Initiative to decrease Healthcare-Associated Infections

Disclaimer

This site express the opinion of the author and not of his employer.

The objective of this blog is to provide updated medical education in Internal Medicine and Pediatrics, with emphasis in controversies or current information in Hospital Medicine.

The information provided in this blog is intended for healthcare professionals only.

All non-healthcare professionals visitors should consult with their physician any specific health questions, and discuss any information provided through this site with their physician before taking any action with regards to their healthcare needs. The information in this blog is NOT intended to provide medical advice.

This blog provides links to websites, including medical journals, medical news feeds, health-care related blogs, etc. These links do not constitute an endorsement of their products, policies, statements or actions.

The author of this blog encourages a critical review of literature and encourage the direct access of peer-reviewed medical journals as primary source of medical information.

Most information provided will be related to direct source data (updated guidelines, medical societies statements, etc.); however the utility of clinical cases as a source of medical education is recognized and therefore interesting and high-yield educational value clinical cases may be used. All clinical cases used will be compliant with patient privacy according with the HIPPA legislation act. (http://www/hhs.gov/ocr/privacy/)

By accessing this blog, the visitors acknowledge there is no physician-patient relationship between them and the author.

FUNDING AND FINANCIAL SUPPORT STATEMENT

- This site is hosted free of charge by Blogger.

- This blog does not host or receive funding from advertisement.

- No comments posted on this blog have the right of posting advertisement of any kind. This blog is strictly academic.

CONFIDENTIALITY (PRIVACY POLICY) STATEMENT

No information is collected from any visitor to this blog. The purpose of this blog is strictly educational. The email address of whomever contact the author of this blog is kept strictly confidential and is not passed to any third party unless required by law.

RULES FOR POSTING COMMENTS

Only registered users and followers of this blog can leave comments.

New comments are moderated. No profanity or politically incorrect statements are allowed. No comments intending to offend any culture, race, country, religion or political beliefs will be permitted.

This is an exclusively medically academic blog with the only intent of provoking thought (intellectual stimulation) and increase medical knowledge. Comments should be merely academic and neutral in political beliefs.