RISK FACTORS: Immunocompromised, Living in close quarters, Seasonal - epidemic upper respiratory illness, Elderly, Cardiac disease, Chronic pulmonary disease, Recent upper respiratory infection,Travel to endemic area (Hantavirus, SARS and Avian)
APPROPRIATE HEALTH CARE
Outpatient for most cases. Inpatient for infants under 4 months of age or elderly, or for any patient with diffuse,
severe infection (hypoxemia, hypercarbia, hypotension or shock, adult respiratory distress syndrome) or
signifi cant comorbidity (CHF, CAD, COPD, etc.)
GENERAL MEASURES
β’ Encourage coughing and deep breathing exercises to clear secretions
β’ Careful disposal of secretions/universal precautions
β’ Hydration
β’ Respiratory isolation for varicella which is highly contagious (i.e., negative pressure)
ACTIVITY
β’ Rest
DIET
β’ Increase fluids, high calorie, high protein, soft diet
DRUG(S) OF CHOICE
. Amantadine (Symmetrel): infl uenza A (not effective for influenza B) - effective only in fi rst 24-48 hours
. Age < 10: 4-8 mg/kg/day in 2 divided doses. Not to exceed 150 mg/day.
. Age 10-65: 100 mg orally q12 h (adults may be given a loading dose of 200 mg initially)
. Age > 65: 100 mg orally once a day
. Acyclovir (Zovirax): pulmonary infections involving herpes simplex, herpes zoster or varicella
. Adults 5 mg/kg IV q8h for HSV pneumonia and 10 mg/kg IV q8h for varicella pneumonia
. Children 250 mg/square meter body surface area IV q8h
. Ganciclovir (Cytovene): CMV infection, HSV infection
. 5 mg/kg IV 12h
. Ribavirin (Virazole): RSV, possibly Hanta and influenza B virus (20 mg/mL via continuous aerosol administration for 12-18 hours/day for 3-7 days). Indicated only in severe RSV infections, given via small particle aerosol generator (SPAG).
. Zanamivir (Relenza) - infl uenza A and B
. Age > 12: 10 mg (2 inhalations) inhaled by mouth q 12 h for 5 days
. Oseltamivir (Tamifl u) - infl uenza A and B
. Age > 18: 75 mg by mouth q 12 h for 5 days. Dose adjusted to 75 mg q 24 h for creatinine clearance <
30 mL/min.