Should you get an advance prescription for antiviral drugs?

The prescription antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) are key tools in managing swine flu symptoms. But they do have side effects, and they can lead to drug resistant viruses. So who should take them and who should take a pass?

Most people don't need antiviral drugs to treat the flu, according to our medical advisors and government health officials. So far, the majority of swine flu cases have been relatively mild. But those with certain risk factors should consider antiviral medication. And everyone should watch out for severe symptoms and seek treatment if necessary.

On Tuesday, the Centers for Disease Control and Prevention issued revised guidance for antiviral drugs. The agency recommends treatment for people with flu symptoms who are:

• Hospitalized or experiencing certain emergency symptoms such as shortness of breath or rapid breathing
• At higher risk for complications, such as pregnant women, children under 5, adults over 65, and people with underlying medical conditions or immune deficiencies, as well as people under 19 years of age on long term aspirin therapy

In these cases, treatment should begin as soon as possible, whether or not the flu is confirmed. After the first 48 hours of the onset of symptoms, the drugs begin to lose their effectiveness. And on that point, the CDC made some recommendations to quicken treatment for those who need it most.

Telephone consultation: To reduce delays, health care providers are encouraged to discuss flu symptoms and treatment with patients on the phone. For such consultation to be effective, patients need to be aware of the signs and symptoms of the flu: rapid onset of fever or chills, muscle aches, headache, and an unproductive cough or sore throat, and may also include diarrhea or vomiting. Also make sure you know the emergency symptoms, so you can seek proper treatment if necessary. High-risk patients should be aware of their need for early treatment. If you think you might be at higher risk talk to your doctor now about phone consultation should flu symptoms arise.

Advance prescription: In some situations, the CDC says, providers may consider an advance prescription for antiviral drugs for those most at risk. That may mean you'll need to call for a consultation to confirm the symptoms and activate the prescription.

Watchful waiting: Few people should consider using antiviral drugs preventively. Those that may include high-risk individuals and any health care workers who come in close contact with an infected person. But the CDC also says that rather than prescribing antiviral drugs preventatively, doctors may consider a watchful waiting approach for those with risk factors who are in close contact with an infected person. That means instead of prescribing an antiviral to prevent transmission, your doctor may ask you to wait and see if symptoms appear before initiating early use of antiviral drugs to control them.

—Kevin McCarthy, associate editor

Follow our swine flu coverage and recommendations and tell us your thoughts on advance prescriptions for antivirals.

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