Logistics Pose an Obstacle for Flu Antiviral Rx

MONTREAL — Although influenza vaccination continues to be underutilized, it is a success story compared with the use of influenza antiviral medications, experts agreed at an international conference on community-acquired pneumonia.

Medications such as zanamivir and oseltamivir can prevent or greatly reduce the major symptoms and sequelae of influenza, including community-acquired pneumonia, yet they do not currently play a central role in influenza management.

“As long as the bean counters are practicing medicine without a license, this is not going to improve,” said Dr. Grant Stiver, professor of medicine and head of infectious diseases at the University of British Columbia, Vancouver. “We put out money for heart transplants in 75-year-old men because we can see they are dying of heart failure, but to put out money for prophylaxis … seems to be a big stumbling block.”

Besides lack of resources to promote the use of influenza antivirals, there is also a lack of awareness, both in the general public and within the medical community.

“Physicians are very reluctant to prescribe antivirals, and the message to patients has been don't go to the doctor if you have a virus,” said Dr. Karl Weiss of the University of Montreal. “We have a long way to go to educate physicians and also the public,” he said at the meeting, which was sponsored by the International Society of Chemotherapy.

“It's a different paradigm. We were all taught in school that there's nothing you can do for a viral infection, but these drugs work, and the faster we use them after symptom onset the better they work,” Dr. Stiver agreed in an interview. And although clinical trials suggest minimal benefits if antivirals are administered more than 36 hours after symptom onset, the window is likely even shorter.

“There are very significant differences between using them at 36 hours and using them at 12 hours or even 24 hours,” he said, noting that a 3-day reduction in symptoms has been shown when the medications are administered within 12 hours. This tight window of opportunity is a major barrier to the medications' widespread use, he said. “Most patients who develop an acute febrile illness, unless they're very, very sick, don't see a doctor for 48 or 36 hours, so it's a matter of education of the public that there is something available.”

He suggested that in the event of an influenza epidemic, a better system needs to be in place to help patients access antivirals quickly. “You can't do this through doctors' offices. There must be some kind of algorithm set up whereby in major epidemics patients can receive the medication through pharmacies with some prearranged prescription from their physician.” This would have to be directed by a public health alert to prevent patients from stockpiling or self-prescribing to treat other noninfluenza viruses, he said.

MONTREAL — Although influenza vaccination continues to be underutilized, it is a success story compared with the use of influenza antiviral medications, experts agreed at an international conference on community-acquired pneumonia.

Medications such as zanamivir and oseltamivir can prevent or greatly reduce the major symptoms and sequelae of influenza, including community-acquired pneumonia, yet they do not currently play a central role in influenza management.

“As long as the bean counters are practicing medicine without a license, this is not going to improve,” said Dr. Grant Stiver, professor of medicine and head of infectious diseases at the University of British Columbia, Vancouver. “We put out money for heart transplants in 75-year-old men because we can see they are dying of heart failure, but to put out money for prophylaxis … seems to be a big stumbling block.”

Besides lack of resources to promote the use of influenza antivirals, there is also a lack of awareness, both in the general public and within the medical community.

“Physicians are very reluctant to prescribe antivirals, and the message to patients has been don't go to the doctor if you have a virus,” said Dr. Karl Weiss of the University of Montreal. “We have a long way to go to educate physicians and also the public,” he said at the meeting, which was sponsored by the International Society of Chemotherapy.

“It's a different paradigm. We were all taught in school that there's nothing you can do for a viral infection, but these drugs work, and the faster we use them after symptom onset the better they work,” Dr. Stiver agreed in an interview. And although clinical trials suggest minimal benefits if antivirals are administered more than 36 hours after symptom onset, the window is likely even shorter.

“There are very significant differences between using them at 36 hours and using them at 12 hours or even 24 hours,” he said, noting that a 3-day reduction in symptoms has been shown when the medications are administered within 12 hours. This tight window of opportunity is a major barrier to the medications' widespread use, he said. “Most patients who develop an acute febrile illness, unless they're very, very sick, don't see a doctor for 48 or 36 hours, so it's a matter of education of the public that there is something available.”

He suggested that in the event of an influenza epidemic, a better system needs to be in place to help patients access antivirals quickly. “You can't do this through doctors' offices. There must be some kind of algorithm set up whereby in major epidemics patients can receive the medication through pharmacies with some prearranged prescription from their physician.” This would have to be directed by a public health alert to prevent patients from stockpiling or self-prescribing to treat other noninfluenza viruses, he said.

MONTREAL — Although influenza vaccination continues to be underutilized, it is a success story compared with the use of influenza antiviral medications, experts agreed at an international conference on community-acquired pneumonia.

Medications such as zanamivir and oseltamivir can prevent or greatly reduce the major symptoms and sequelae of influenza, including community-acquired pneumonia, yet they do not currently play a central role in influenza management.

“As long as the bean counters are practicing medicine without a license, this is not going to improve,” said Dr. Grant Stiver, professor of medicine and head of infectious diseases at the University of British Columbia, Vancouver. “We put out money for heart transplants in 75-year-old men because we can see they are dying of heart failure, but to put out money for prophylaxis … seems to be a big stumbling block.”

Besides lack of resources to promote the use of influenza antivirals, there is also a lack of awareness, both in the general public and within the medical community.

“Physicians are very reluctant to prescribe antivirals, and the message to patients has been don't go to the doctor if you have a virus,” said Dr. Karl Weiss of the University of Montreal. “We have a long way to go to educate physicians and also the public,” he said at the meeting, which was sponsored by the International Society of Chemotherapy.

“It's a different paradigm. We were all taught in school that there's nothing you can do for a viral infection, but these drugs work, and the faster we use them after symptom onset the better they work,” Dr. Stiver agreed in an interview. And although clinical trials suggest minimal benefits if antivirals are administered more than 36 hours after symptom onset, the window is likely even shorter.

“There are very significant differences between using them at 36 hours and using them at 12 hours or even 24 hours,” he said, noting that a 3-day reduction in symptoms has been shown when the medications are administered within 12 hours. This tight window of opportunity is a major barrier to the medications' widespread use, he said. “Most patients who develop an acute febrile illness, unless they're very, very sick, don't see a doctor for 48 or 36 hours, so it's a matter of education of the public that there is something available.”

He suggested that in the event of an influenza epidemic, a better system needs to be in place to help patients access antivirals quickly. “You can't do this through doctors' offices. There must be some kind of algorithm set up whereby in major epidemics patients can receive the medication through pharmacies with some prearranged prescription from their physician.” This would have to be directed by a public health alert to prevent patients from stockpiling or self-prescribing to treat other noninfluenza viruses, he said.