.diabetes mellitus.
The Department of Health in England has advised
(November 2010 and April 2011 ) that‘at risk patients’also
includes patients under^65 years of age who are at risk of
developing medical complications from influenza
(treatment only) or women who are pregnant.
This guidance does not cover the circumstances of a
pandemic, an impending pandemic, or a widespread
epidemic of a new strain of influenza to which there is
little or no immunity in the community.
http://www.nice.org.uk/guidance/TA158
▶Oseltamivir, zanamivir, and amantadine for treatment of
influenza (February 2009 )NICE TA168
Zanamivir isnota substitute for vaccination, which
remains the most effective way of preventing illness from
influenza.
.When influenza is circulating in the community,
zanamivir is an option recommended (in accordance
with UK licensing) for the treatment of influenza in at-
risk patients who can start treatment within 48 hours
(within 36 hours for zanamivir in children) of the onset
of symptoms. (National surveillance schemes, including
those run by Public Health England, should be used to
indicate when influenza is circulating in the
community.)
.During local outbreaks of influenza-like illness, when
there is a high level of certainty that influenza is
present, zanamivir may be used for treatment in at-risk
patients living in long-term residential or nursing
homes.
At risk patients include those aged over 65 yearsorthose
who have one or more of the following conditions:
.chronic respiratory disease (including asthma and
chronic obstructive pulmonary disease);
.chronic heart disease;
.chronic renal disease;
.chronic liver disease;
.chronic neurological disease;
.immunosuppression;
.diabetes mellitus.
The Department of Health in England has advised
(November 2010 and April 2011 ) that‘at risk patients’also
includes patients under 65 years of age who are at risk of
developing medical complications from influenza
(treatment only) or women who are pregnant.
This guidance does not cover the circumstances of a
pandemic, an impending pandemic, or a widespread
epidemic of a new strain of influenza to which there is
little or no immunity in the community.
http://www.nice.org.uk/guidance/TA168lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Inhalation powder
▶Relenza(GlaxoSmithKline UK Ltd)
Zanamivir 5 mgRelenza 5 mg inhalation powder blisters with
Diskhaler| 20 blisterP£ 16. 366.6 Respiratory syncytial virus
Respiratory syncytial virus
Management
Ribavirin p. 400 inhibits a wide range of DNA and RNA
viruses. It is licensed for administration by inhalation for the
treatment of severe bronchiolitis caused by the respiratory
syncytial virus (RSV) in infants, especially when they have
other serious diseases. However, there is no evidence that
ribavirin produces clinically relevant benefit in RSVbronchiolitis. Ribavirin is effective in Lassa fever and has
also been used parenterally in the treatment of life-
threatening RSV, parainfluenza virus, and adenovirus
infections in immunocompromised children [unlicensed
indications].
Palivizumab below is a monoclonal antibody licensed for
preventing serious lower respiratory-tract disease caused by
respiratory syncytial virus in children at high risk of the
disease; it should be prescribed under specialist supervision
and on the basis of the likelihood of hospitalisation.
Palivizumab is recommended for:
.children under 9 months of age with chronic lung disease
(defined as requiring oxygen for at least 28 days from
birth) and who were born preterm;
.children under 6 months of age with haemodynamically
significant, acyanotic congenital heart disease who were
born preterm.
Palivizumab should be considered for:
.children under 2 years of age with severe combined
immunodeficiency syndrome;
.children under 1 year of age who require long-term
ventilation;
.children 1 – 2 years of age who require long-term
ventilation and have an additional co-morbidity (including
cardiac disease or pulmonary hypertension).
For details of the preterm age groups included in the
recommendations, seeImmunisation against Infectious
Disease( 2006 ), available atwww.gov.uk/dh.DRUGS FOR RESPIRATORY DISEASES›
MONOCLONAL ANTIBODIESPalivizumab
lINDICATIONS AND DOSE
Prevention of serious lower respiratory-tract disease
caused by respiratory syncytial virus in children at high
risk of the disease (under expert supervision)
▶BY INTRAMUSCULAR INJECTION
▶Neonate: 15 mg/kg once a month, preferably injected in
the anterolateral thigh, to be administered during
season of RSV risk.▶Child 1–23 months: 15 mg/kg once a month, preferably
injected in the anterolateral thigh, to be administered
during season of RSV risk, injection volume over 1 mL
should be divided between 2 or more sites
Prevention of serious lower respiratory-tract disease
caused by respiratory syncytial virus in children at high
risk of the disease and undergoing cardiac bypass
surgery (under expert supervision)
▶BY INTRAMUSCULAR INJECTION
▶Child 1–23 months:Initially 15 mg/kg, to be
administered as soon as stable after surgery, preferably
in the anterolateral thigh, then 15 mg/kg once a
month, preferably injected in the anterolateral thigh,
to be administered during season of RSV risk, injection
volume over 1 mL should be divided between 2 or more
siteslUNLICENSED USELicensed for the prevention of serious
lower respiratory-tract disease caused by respiratory
syncytial virus (RSV) in children under 6 months of age (at
the start of the RSV season) and born at less than 35 weeks
corrected gestational age, or in children under 2 years of
age who have received treatment for bronchopulmonary
dysplasia in the last 6 months, or in children under 2 years
of age with haemodynamically significant congenital heart
disease.430 Viral infection BNFC 2018 – 2019
Infection5