Viral Infections

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CHAPTER 27 Viral Infections PART 9 LEARNING OBJECTIVES PRONUNCIatIONS After completing this chapter, you should be able to Adenopathy (ad-en-OP-uh-thee) 1. Define the following: Adenoviruses (AD-eh-noh-VIE-rus- ez) • AIDS Cytomegalovirus (sie-toh-MEG-uh- • DNA loh-VIE-rus) Entero viruses (EN-ter-oh-VIE-rus- • RNA ez) • Virus Epstein-Barr (EP-steen BAR) 2. Describe common types of viral infections Herpes (HER-peez) 3. Differentiate between viral infections treated with antiviral therapy and those whose Interferons (in ter FEER onz) treatment is restricted to supportive care Keratoconjunctivitis (KAYR-uh-toh- kun-junk-tih-VIE-tis) 4. Describe the different types of antiviral medications and the targets of action of Microbicide (mie-KROH-bi-sied) each Oncogenic (on-koh-JEN-ik) 5. List major adverse effects, cautions, and drug interactions for antiviral medications Replicate (REH-pli-kayt) Rhinoviruses (RIE-noh-VIE-rus-ez) Syncytial (sin-SISH-ul) Vesicles (VES-ih-kulz) Workbook for Understanding Pharmacology for Pharmacy Technicians 102 Matching I Matching II Match each brand name antiviral preparation to its generic Match each brand name antiretroviral agent (all used for name and list the type of viral infection(s) for which it is HIV) with its generic name and mechanism of action. used. For additional study, list the route of administration for each. Generic Brand Names Names Mechanism of Action Generic Route of 1. Aptivus Brand Names Names Indication(s) Administration 2. Crixivan 1. Baraclude 3. Edurant 2. Copegus 4. Emtriva 3. Cytovene 5. Epivir 4. Famvir 6. Fuzeon 5. Flumadine 7. Intelence 6. Hepsera 8. Invirase 7. Infergen 9. Lexiva 8. Intron A 10. Norvir 9. Pegasys 11. Prezista 10. PegIntron 12. Rescriptor 11. Rebetol 13. Retrovir 12. Relenza 14. Reyataz 13. Sylatron 15. Sustiva 14. Tamiflu 16. Videx 15. Valcyte 17. Viracept 16. Valtrex 18. Viramune 17. Virazole 19. Zerit 18. Vistide 20. Ziagen 19. Zirgan 20. Zovirax GENERIC NAMES GENERIC NAMES a. abacavir k. indinavir b. atazanavir l. lamivudine a. acyclovir i. oseltamivir c. darunavir m. nelfinavir b. adefovir j. peginterferon alfa-2a d. delavirdine n. nevirapine c. cidofovir k. peginterferon alfa-2b e. didanosine o. rilpivirine d. entecavir l. ribavirin f. efavirenz p. ritonavir e. famciclovir m. rimantadine g. emtricitabine q. saquinavir f. ganciclovir n. valacyclovir h. enfuvirtide r. stavudine g. interferon alfa-2b o. valganciclovir i. etravirine s. tipranavir h. interferon alfacon-1 p. zanamivir j. fosamprenavir t. zidovudine INDICATIONS MECHANISMS OF ACTION CMV = Cytomegalovirus Influenza A Entry Inhibitor HBV= Hepatitis B Influenza B NNRTI = Non-nucleoside reverse transcriptase inhibitor HCV = Hepatitis C NRTI = Nucleoside reverse transcriptase inhibitor HSV = Herpes viruses PI = Protease inhibitor RSV = Respiratory syncytial virus.

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Highlights of Prescribing Information
HIGHLIGHTS OF PRESCRIBING INFORMATION --------------------------WARNINGS AND PRECAUTIONS-------------------- These highlights do not include all the information needed to use • New onset or worsening renal impairment: Can include acute VIREAD safely and effectively. See full prescribing information renal failure and Fanconi syndrome. Assess creatinine clearance for VIREAD. (CrCl) before initiating treatment with VIREAD. Monitor CrCl and ® serum phosphorus in patients at risk. Avoid administering VIREAD (tenofovir disoproxil fumarate) tablets, for oral use VIREAD with concurrent or recent use of nephrotoxic drugs. (5.3) VIREAD® (tenofovir disoproxil fumarate) powder, for oral use • Coadministration with Other Products: Do not use with other Initial U.S. Approval: 2001 tenofovir-containing products (e.g., ATRIPLA, COMPLERA, and TRUVADA). Do not administer in combination with HEPSERA. WARNING: LACTIC ACIDOSIS/SEVERE HEPATOMEGALY WITH (5.4) STEATOSIS and POST TREATMENT EXACERBATION OF HEPATITIS • HIV testing: HIV antibody testing should be offered to all HBV- infected patients before initiating therapy with VIREAD. VIREAD See full prescribing information for complete boxed warning. should only be used as part of an appropriate antiretroviral • Lactic acidosis and severe hepatomegaly with steatosis, combination regimen in HIV-infected patients with or without HBV including fatal cases, have been reported with the use of coinfection. (5.5) nucleoside analogs, including VIREAD. (5.1) • Decreases in bone mineral density (BMD): Consider assessment • Severe acute exacerbations of hepatitis have been reported of BMD in patients with a history of pathologic fracture or other in HBV-infected patients who have discontinued anti- risk factors for osteoporosis or bone loss. (5.6) hepatitis B therapy, including VIREAD. Hepatic function • Redistribution/accumulation of body fat: Observed in HIV-infected should be monitored closely in these patients.
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COVID-19) Pandemic on National Antimicrobial Consumption in Jordan
antibiotics Article An Assessment of the Impact of Coronavirus Disease (COVID-19) Pandemic on National Antimicrobial Consumption in Jordan Sayer Al-Azzam 1, Nizar Mahmoud Mhaidat 1, Hayaa A. Banat 2, Mohammad Alfaour 2, Dana Samih Ahmad 2, Arno Muller 3, Adi Al-Nuseirat 4 , Elizabeth A. Lattyak 5, Barbara R. Conway 6,7 and Mamoon A. Aldeyab 6,* 1 Clinical Pharmacy Department, Jordan University of Science and Technology, Irbid 22110, Jordan; [email protected] (S.A.-A.); [email protected] (N.M.M.) 2 Jordan Food and Drug Administration (JFDA), Amman 11181, Jordan; [email protected] (H.A.B.); [email protected] (M.A.); [email protected] (D.S.A.) 3 Antimicrobial Resistance Division, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland; [email protected] 4 World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt; [email protected] 5 Scientific Computing Associates Corp., River Forest, IL 60305, USA; [email protected] 6 Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; [email protected] 7 Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK * Correspondence: [email protected] Citation: Al-Azzam, S.; Mhaidat, N.M.; Banat, H.A.; Alfaour, M.; Abstract: Coronavirus disease 2019 (COVID-19) has overlapping clinical characteristics with bacterial Ahmad, D.S.; Muller, A.; Al-Nuseirat, respiratory tract infection, leading to the prescription of potentially unnecessary antibiotics. This A.; Lattyak, E.A.; Conway, B.R.; study aimed at measuring changes and patterns of national antimicrobial use for one year preceding Aldeyab, M.A.
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Dectova, INN-Zanamivir
28 February 2019 EMA/CHMP/851480/2018 Committee for Medicinal Products for Human Use (CHMP) Assessment report DECTOVA International non-proprietary name: zanamivir Procedure No. EMEA/H/C/004102/0000 Note Assessment report as adopted by the CHMP with all information of a commercially confidential nature deleted. Official address Domenico Scarlattilaan 6 ● 1083 HS Amsterdam ● The Netherlands Address for visits and deliveries Refer to www.ema.europa.eu/how-to-find-us Send us a question Go to www.ema.europa.eu/contact Telephone +31 (0)88 781 6000 An agency of the European Union © European Medicines Agency, 2019. Reproduction is authorised provided the source is acknowledged. Table of contents 1. Background information on the procedure .............................................. 7 1.1. Submission of the dossier ...................................................................................... 7 1.2. Steps taken for the assessment of the product ......................................................... 9 2. Scientific discussion .............................................................................. 12 2.1. Problem statement ............................................................................................. 12 2.1.1. Disease or condition ......................................................................................... 12 2.1.2. Epidemiology .................................................................................................. 12 2.1.3. Biologic features .............................................................................................
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Truvada (Emtricitabine / Tenofovir Disoproxil)
Pre-exposure Prophylaxis (2.3) HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use Recommended dose in HIV-1 uninfected adults: One tablet TRUVADA safely and effectively. See full prescribing information (containing 200 mg/300 mg of emtricitabine and tenofovir for TRUVADA. disoproxil fumarate) once daily taken orally with or without food. (2.3) TRUVADA® (emtricitabine/tenofovir disoproxil fumarate) tablets, for oral use Recommended dose in renally impaired HIV-uninfected Initial U.S. Approval: 2004 individuals: Do not use TRUVADA in HIV-uninfected individuals if CrCl is below 60 mL/min. If a decrease in CrCl is observed in WARNING: LACTIC ACIDOSIS/SEVERE HEPATOMEGALY WITH uninfected individuals while using TRUVADA for PrEP, evaluate STEATOSIS, POST-TREATMENT ACUTE EXACERBATION OF potential causes and re-assess potential risks and benefits of HEPATITIS B, and RISK OF DRUG RESISTANCE WITH USE OF continued use. (2.4) TRUVADA FOR PrEP IN UNDIAGNOSED HIV-1 INFECTION -----------------------DOSAGE FORMS AND STRENGTHS------------------- See full prescribing information for complete boxed warning. Tablets: 200 mg/300 mg, 167 mg/250 mg, 133 mg/200 mg, and 100 Lactic acidosis and severe hepatomegaly with steatosis, mg/150 mg of emtricitabine and tenofovir disoproxil fumarate . (3) including fatal cases, have been reported with the use of nucleoside analogs, including VIREAD, a component of TRUVADA. (5.1) --------------------------------CONTRAINDICATIONS----------------------------- TRUVADA is not approved for the treatment of chronic Do not use TRUVADA for pre-exposure prophylaxis in individuals with hepatitis B virus (HBV) infection. Severe acute unknown or positive HIV-1 status. TRUVADA should be used in exacerbations of hepatitis B have been reported in patients HIV-infected patients only in combination with other antiretroviral coinfected with HIV-1 and HBV who have discontinued agents.
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Which Drugs Are Most Effective for Recurrent Herpes Labialis?
Evidence-based answers from the clinical inquiries Family Physicians Inquiries Network Eiko Tubridy, MD; Gary Kelsberg, MD Valley Family Residency Which drugs are most Program, Renton, Wash Leilani St Anna, MLIS, effective for recurrent AHIP University of Washington Health Sciences Libraries, herpes labialis? Seattle AssistanT EDITOR EvidEncE-basEd answEr Jon O. neher, MD Valley Family Residency daily oral acyclovir or vala- ing to the agent used: valacyclovir reduces Program, Renton, Wash A cyclovir may help prevent her- both healing time and duration of pain, pes simplex labialis (HSL) recurrences famciclovir reduces both in one dosage (strength of recommendation [SOR]: B, form but not another, and acyclovir reduces meta-analysis of randomized controlled only pain duration (SOR: B, single RCTs). trials [RCTs] with heterogeneous results). Several topical medications (acyclovir, No trials compare oral or topical treat- penciclovir, docosanol) modestly decrease ments for HSL outbreaks against each oth- healing time and pain duration—typically er. Oral antivirals modestly reduce healing by less than a day—and require multiple time and duration of pain, varying accord- doses per day (SOR: B, multiple RCTs). Evidence summary The authors of the meta-analysis noted A systematic review and meta-analysis of the that although 9 studies favored the use of an effectiveness of oral and topical nucleoside antiviral drug, only 4 showed statistically sig- antiviral agents to prevent recurrent HSL in nificant differences when compared with pla- immunocompetent people found 11 RCTs cebo, and none of them had a low risk of bias. with a total of 1250 patients that compared They concluded that the review supported us- an active drug against placebo.1 The medi- ing oral acyclovir and valacyclovir to prevent cations were topical 5% acyclovir, topical 1% recurrent HSL.1 penciclovir, and oral acyclovir, valacyclovir, or famciclovir in various doses.
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Debate Regarding Oseltamivir Use for Seasonal and Pandemic Influenza
Debate Regarding Oseltamivir Use for Seasonal and Pandemic Influenza Aeron Hurt WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia www.influenzacentre.org NA inhibitor antiviral drugs Top view of NA NA inhibitor NA enzyme active site The NA inhibitors Oseltamivir Zanamivir - Oral, IV(?) - Inhaled, IV(?) - Global - Global Peramivir Laninamivir -IV - Inhaled (single) - Japan, - Japan S.Korea, China, US The NA inhibitors Oseltamivir Zanamivir - Oral, IV(?) - Inhaled, IV(?) - Global - Global • Came on the market in many countries in 2000 after clinical studies had been conducted among influenza virus–infected patients with uncomplicated illness. • Oseltamivir is market leader ……due to ease of oral administration • Use for seasonal influenza mainly in Japan and US • With human infections of highly pathogenic influenza A(H5N1) virus from 2003 with a high case‐fatality risks of >50%, governments began to consider antiviral drug administration as a key component of their pandemic response • suitable vaccines would not be available Stockpiling for a pandemic • Oseltamivir was simpler (oral) administration than zanamivir (inhalation) and because of systemic effect of oseltamivir was expected to be appropriate for treatment of highly pathogenic viruses • Oseltamivir was suddenly in high demand! • Roche had warned that need to stockpile to guarantee availability • Since 2005, governments of middle‐income and high‐income countries around the world have spent billions of dollars (estimated) stockpiling oseltamivir (US Gov. Accounting Office). 2009 A(H1N1)pdm09 pandemic • The first pandemic of the 21st century occurred unexpectedly in 2009 after the global spread of a novel virus—influenza A(H1N1)pdm09—of swine (rather than avian) origin.
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Reference ID: 2998411
• New onset or worsening renal impairment: Can include acute HIGHLIGHTS OF PRESCRIBING INFORMATION renal failure and Fanconi syndrome. Assess creatinine clearance These highlights do not include all the information needed to use (CrCl) before initiating treatment with COMPLERA. Monitor CrCl COMPLERA safely and effectively. See full prescribing and serum phosphorus in patients at risk. Avoid administering information for COMPLERA. COMPLERA with concurrent or recent use of nephrotoxic drugs. (5.3) COMPLERATM (emtricitabine/rilpivirine/tenofovir disoproxil • Caution should be given to prescribing COMPLERA with drugs fumarate) tablets that may reduce the exposure of rilpivirine. (5.4) Initial U.S. Approval: 2011 • Caution should be given to prescribing COMPLERA with drugs with a known risk of Torsade de Pointes. (5.4) WARNINGS: LACTIC ACIDOSIS/SEVERE HEPATOMEGALY WITH STEATOSIS and POST TREATMENT ACUTE • Depressive disorders: Severe depressive disorders (depressed EXACERBATION OF HEPATITIS B mood, depression, dysphoria, major depression, mood altered, negative thoughts, suicide attempt, suicidal ideation) have been See full prescribing information for complete boxed warning. reported. Immediate medical evaluation is recommended for severe depressive disorders. (5.5) • Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of • Decreases in bone mineral density (BMD): Consider monitoring nucleoside analogs, including tenofovir disoproxil BMD in patients with a history of pathologic fracture
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Novel Therapeutics for Epstein–Barr Virus
molecules Review Novel Therapeutics for Epstein–Barr Virus Graciela Andrei *, Erika Trompet and Robert Snoeck Laboratory of Virology and Chemotherapy, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium; [email protected] (E.T.); [email protected] (R.S.) * Correspondence: [email protected]; Tel.: +32-16-321-915 Academic Editor: Stefano Aquaro Received: 15 February 2019; Accepted: 4 March 2019; Published: 12 March 2019 Abstract: Epstein–Barr virus (EBV) is a human γ-herpesvirus that infects up to 95% of the adult population. Primary EBV infection usually occurs during childhood and is generally asymptomatic, though the virus can cause infectious mononucleosis in 35–50% of the cases when infection occurs later in life. EBV infects mainly B-cells and epithelial cells, establishing latency in resting memory B-cells and possibly also in epithelial cells. EBV is recognized as an oncogenic virus but in immunocompetent hosts, EBV reactivation is controlled by the immune response preventing transformation in vivo. Under immunosuppression, regardless of the cause, the immune system can lose control of EBV replication, which may result in the appearance of neoplasms. The primary malignancies related to EBV are B-cell lymphomas and nasopharyngeal carcinoma, which reﬂects the primary cell targets of viral infection in vivo. Although a number of antivirals were proven to inhibit EBV replication in vitro, they had limited success in the clinic and to date no antiviral drug has been approved for the treatment of EBV infections. We review here the antiviral drugs that have been evaluated in the clinic to treat EBV infections and discuss novel molecules with anti-EBV activity under investigation as well as new strategies to treat EBV-related diseases.
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Comparable Efficacy with Entecavir Monotherapy and Tenofovir
BMJ Open Gastroenterol: first published as 10.1136/bmjgast-2015-000030 on 31 December 2015. Downloaded from Hepatology Comparable efﬁcacy with entecavir monotherapy and tenofovir–entecavir combination in chronic hepatitis B patients Sumbella Baqai,1 James Proudfoot,2 Ronghui Xu,3,4 Steve Kane,5 Margaret Clark,6 Robert Gish,7,8,9,10,11 To cite: Baqai S, Proudfoot J, ABSTRACT et al Summary box Xu R, . Comparable Objectives: The long-term goal for chronic hepatitis B efficacy with entecavir patients is to maintain viral suppression in order to monotherapy and tenofovir– What is already known about this subject? reduce disease progression risk. Because patients with entecavir combination in ▸ Finding effective therapy for patients with chronic hepatitis B patients. previous treatment failure may have multiple viral chronic hepatitis B virus (HBV) infection who BMJ Open Gastro 2015;2: resistance mutations, finding effective therapy is e000030. doi:10.1136/ challenging. Because recent studies have shown that have had previous treatment failure, many of bmjgast-2015-000030 the combination of entecavir and tenofovir is effective whom have multiple viral resistance mutations, in achieving virological response in many patients with is a challenge. prior treatment failure and multiple drug resistance ▸ Several recent studies have shown that combin- ation therapy with entecavir (ETV) and tenofovir Received 27 January 2015 mutations, we compared outcomes with this Revised 22 April 2015 combination versus monotherapy. (TDF) is effective in achieving virological by copyright. Accepted 30 April 2015 Methods: With a retrospective chart review we response in the majority of patients with prior compared results in 35 patients with previous treatment treatment failure and multiple drug resistance failure treated with the entecavir-tenofovir combination to mutations.
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AUSTRALIAN PRODUCT INFORMATION Valcyte® (Valganciclovir Hydrochloride)
AUSTRALIAN PRODUCT INFORMATION Valcyte® (valganciclovir hydrochloride) 1. NAME OF THE MEDICINE Valganciclovir (as hydrochloride) 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Valcyte is available as film-coated tablets and as powder for oral solution. Each film coated tablet contains 496.3 mg valganciclovir HCl (corresponding to 450 mg valganciclovir). The powder is reconstituted to form an oral solution, containing 55 mg valganciclovir HCl per mL (equivalent to 50 mg valganciclovir). Excipients with known effect The powder for oral solution contains a total of 0.188 mg/mL sodium. For the full list of excipients, see section 6.1. List of excipients 3. PHARMACEUTICAL FORM Valcyte tablets Valcyte (valganciclovir HCl) is available as 450 mg pink convex oval tablets with "VGC" on one side and "450" on the other side. Each film-coated tablet contains 450 mg valganciclovir. Valcyte is supplied in bottles of 60 tablets. Valcyte powder for oral solution Valcyte powder is white to slightly yellow. The reconstituted solution contains 50 mg/mL valganciclovir and appears clear, colourless to brownish-yellow in colour. 4. CLINICAL PARTICULARS 4.1 THERAPEUTIC INDICATIONS Valcyte is indicated for the treatment of cytomegalovirus (CMV) retinitis in adult patients with acquired immunodeficiency syndrome (AIDS). Valcyte is indicated for the prophylaxis of CMV disease in adult and paediatric solid organ transplantation (SOT) patients who are at risk. 4.2 DOSE AND METHOD OF ADMINISTRATION Dose Caution – Strict adherence to dosage recommendations is essential to avoid overdose. Valganciclovir is rapidly and extensively converted to the active ingredient ganciclovir. The bioavailability of ganciclovir from Valcyte is up to 10-fold higher than from oral ganciclovir, ropvaley11020 1 therefore the dosage and administration of Valcyte tablets or powder for oral solution as described below should be closely followed (see sections 4.4 Special warnings and precautions for use and 4.9 Overdose).
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Treatment of Warts with Topical Cidofovir in a Pediatric Patient
Volume 25 Number 5| May 2019| Dermatology Online Journal || Case Report 25(5):6 Treatment of warts with topical cidofovir in a pediatric patient Melissa A Nickles BA, Artem Sergeyenko MD, Michelle Bain MD Affiliations: Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, llinois, USA Corresponding Author: Artem Sergeyenko MD, 808 South Wood Street Suite 380, Chicago, IL 60612, Tel: 847-338-0037, Email: a.serge04@gmail topical cidofovir is effective in treating HPV lesions Abstract and molluscum contagiosum in adult patients with Cidofovir is an antiviral nucleotide analogue with HIV/AIDS [2]. Case reports have also found topical relatively new treatment capacities for cidofovir to effectively treat anogenital squamous dermatological conditions, specifically verruca cell carcinoma (SCC), bowenoid papulosis, vulgaris caused by human papilloma virus infection. condyloma acuminatum, Kaposi sarcoma, and HSV-II In a 10-year old boy with severe verruca vulgaris in adult patients with HIV/AIDS [3]. Cidofovir has recalcitrant to multiple therapies, topical 1% experimentally been shown to be effective in cidofovir applied daily for eight weeks proved to be an effective treatment with no adverse side effects. treating genital condyloma acuminata in adult This case report, in conjunction with multiple immunocompetent patients [4] and in a pediatric published reports, suggests that topical 1% cidofovir case [5]. is a safe and effective treatment for viral warts in Cidofovir has also been used in pediatric patients to pediatric patients. cure verruca vulgaris recalcitrant to traditional treatment therapies. There have been several reports Keywords: cidofovir, verruca vulgaris, human papilloma that topical 1-3% cidofovir cream applied once or virus twice daily is effective in treating verruca vulgaris with no systemic side effects and low rates of recurrence in immunocompetent children [6-8], as Introduction well as in immunocompromised children [9, 10].
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Influenza: Diagnosis and Treatment
Influenza: Diagnosis and Treatment David Y. Gaitonde, MD; Cpt. Faith C. Moore, USA, MC; and Maj. Mackenzie K. Morgan, USA, MC Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia Influenza is an acute viral respiratory infection that causes significant morbidity and mortality worldwide. Three types of influ- enza cause disease in humans. Influenza A is the type most responsible for causing pandemics because of its high susceptibility to antigenic variation. Influenza is highly contagious, and the hallmark of infection is abrupt onset of fever, cough, chills or sweats, myalgias, and malaise. For most patients in the outpatient setting, the diagnosis is made clinically, and laboratory con- firmation is not necessary. Laboratory testing may be useful in hospitalized patients with suspected influenza and in patients for whom a confirmed diagnosis will change treatment decisions. Rapid molecular assays are the preferred diagnostic tests because they can be done at the point of care, are highly accurate, and have fast results. Treatment with one of four approved anti-influenza drugs may be considered if the patient presents within 48 hours of symptom onset. The benefit of treatment is greatest when antiviral therapy is started within 24 hours of symptom onset. These drugs decrease the duration of illness by about 24 hours in otherwise healthy patients and may decrease the risk of serious complications. No anti-influenza drug has been proven superior. Annual influenza vaccination is recommended for all people six months and older who do not have contraindications. (Am Fam Physician. 2019; 100:online. Copyright © 2019 American Academy of Family Physicians.) Published online November 11, 2019 BEST PRACTICES IN INFECTIOUS DISEASE Influenza is an acute respiratory infection caused by a negative-strand RNA virus of the Orthomyxoviridae fam- Recommendations from the Choosing ily.
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