Treatment for flu (influenza)

If you feel seriously ill, you should always visit your doctor. Only your doctor will be able to tell you if you have a condition that requires treatment or if bed rest and fluids are all you need to get better. If you think you have the flu, visit your doctor as soon as symptoms start (within 2 days)

General Treatment

• Give ONLY non-aspirin medicines such as acetaminophen (Tylenol) to children for fever, muscle aches and headaches.
• Ibuprofen-containing pain relievers (e.g., Advil or Motrin) can be used for fever and pain in older adolescents and adults.
• Drink plenty of fluids to prevent secretions from getting thick and increasing breathing problems.
• Rest to help your body fight the infection.
• Antiviral medicines can be used. (See below.)
• Antibiotics are of absolutely no use for influenza and are used only for bacterial complications after the acute phase is over.

Antiviral Agents

The New Flu Drugs – Neuraminidase Inhibitors

• An exciting new class of drugs is just now becoming available for the treatment of influenza. These drugs, called neuraminidase inhibitors, help stop influenza virus replication and are active against influenza types A and B.
• Zanamivir for inhalation (Relenza®, a trademark of GlaxoWellcome) is the first of these new drugs to be approved by the FDA.
• Relenza has been shown to shorten the duration of flu symptoms if given within 48 hours of symptom onset. Thus it is important to see your doctor at the first sign of flu symptoms to receive effective treatment.
• Relenza, which is administered with the help of a special inhaler, is approved for use in those 12 years of age and older. The normal dosage is two inhalations for 5 days.
• Another new drug in this class is oseltamivir (Tamiflu®, a trademark of Roche). Like Relenza, Tamiflu has been shown to shorten the duration of flu symptoms if taken within 48 hours of symptom onset. Tamiflu, however, is a pill that can be taken orally. Tamiflu has recently been approved for use for treating children and for preventive use.

Amantadine and Rimantadine – Two Older Drugs for Flu

• Amantadine (Symmetrel) and rimantadine (Flumadine), which are effective in treating influenza A infection, have been around for a long time. These drugs interfere with the reproductive cycle of influenza type A viruses. They are only effective against type A viruses and are not effective against type B.
• Amantadine and rimantadine can reduce the severity and shorten the duration of influenza A illness when administered within 48 hours of symptom onset.
• Amantadine can be used to treat children 1 year old or older. Insufficient studies have been done to determine the effectiveness of rimantadine treatment in children who are under 13 years of age. It is currently approved only for prevention of flu in children – not treatment.
• Duration of treatment is usually 3-5 days during the course of the illness, or for 24-48 hours after the disappearance of signs and symptoms.

Zanamivir Side Effects

• Side effects of zanamivir are comparable to placebo.
• The most common side effects are diarrhea, nausea and sinusitis.
• Safety and effectiveness have not been established in patients with high-risk underlying medical conditions, such as chronic obstructive pulmonary disease (COPD) or asthma.
• Patients with asthma or COPD may experience bronchospasm with zanamivir, and should have a fast-acting inhaled bronchodilator available.

Amantadine and Rimantadine Side Effects

• Amantadine and rimantadine may cause adverse (but not severe) reactions in some persons. Side effects may include headache, dizziness, insomnia, irritability, trouble concentrating, and anxiety. These symptoms go away quickly when medication is stopped.
• Rare but serious side effects may include marked behavioral changes, delirium, hallucinations, or seizures. These side effects have been associated with high plasma drug concentrations and are most often observed in elderly persons on prolonged treatment.
• Some persons with renal insufficiency, seizure disorders or certain psychiatric disorders who take more than the normal dosage of 200 mg of amantadine per day for over 5 days may also experience severe side effects. Clinical observations and studies provide evidence that lowering the dosage of amantadine in these persons will reduce the incidence and severity of such side effects.
• Modifications in dosage of amantadine or rimantadine may also be required for persons with impaired renal or hepatic function, the elderly, children, and persons with a history of seizures.