WHO Guidelines for Pharmacological Management of Pandemic Influenza A(H1N1) 2009 and Other Influenza Viruses

Overview

The purpose of this document is to provide a basis for advice to clinicians on the use of the currently available antivirals for patients presenting with illness due to influenza virus infection as well the potential use of the medicines for chemoprophylaxis. The document addresses specifically the two neuraminidase inhibitors oseltamivir and zanamivir, and the two M2 inhibitors amantadine and rimantadine. It includes recommendations on the use of some other potential pharmacological treatments. While the focus of the document is on management of patients with pandemic influenza (H1N1) 2009 virus infection, the document includes guidance on the use of the antivirals for other seasonal influenza virus strains, and for infections due to novel influenza A virus strains. WHO recommends that country and local public health authorities issue local guidance for clinicians from time to time that places these recommendations in the context of epidemiological and antiviral susceptibility data on the locally circulating influenza strains.

Contents

• Part 1. Recommendations
  • Summary
    • Use of antivirals for treatment of influenza
  • 1. Introduction
  • 2. Case description
    • Uncomplicated influenza
    • Complicated or severe influenza
    • Signs and symptoms of progressive disease
  • 3. Risk groups
  • 4. Epidemiology
  • 5. General Considerations
  • 6. Recommendations
    • 6.1 Use of antivirals for treatment of pandemic influenza A (H1N1) 2009 virus infection in adults and adolescents
    • 6.2 Use of antivirals for treatment of uncomplicated pandemic influenza A (H1N1) 2009 virus infection in adults and adolescents
    • 6.3 Use of antivirals for treatment of pandemic influenza A (H1N1) 2009 virus infection in children
    • 6.4 Use of antivirals where antiviral resistance is known or suspected
    • 6.5 Antiviral treatment recommendations: Other influenza virus strains
    • 6.6 Use of antivirals for chemoprophylaxis of pandemic influenza A (H1N1) 2009 virus infection
    • 6.7 Other considerations
  • 7. Other interventions for management of patients with influenza
  • 8. Product supply
  • 9. Priorities for update
    • Plans for updating this guideline
    • Updating or adapting recommendations locally
  • 10. Priorities for research
  • Annex 1 Risk factors for severe disease
  • Annex 2 List of participants
  • Annex 3 Declarations of Interests
  • Annex 4 Table of standard dosages
• Part 2. Review of evidence
  • Summary of Evidence for Benefits and Harms
    • 1 Treatment of Seasonal or Pandemic Influenza
    • 2 Chemoprophylaxis of Influenza
  • Annex 4 Methods used to prepare guidelines
  • Annex 5 Summaries of findings tables
  • Annex 6 Summary of observational data
  • Annex 7 Independent evaluation of oseltamivir dosing in children
  • Annex 8 Review of extemporaneous preparations of oseltamivir
  • References