Podcasts about Oseltamivir

Big Pharma, Big Tech, and the Deep State don't want you to hear this conversation, but Dr. Pierre Kory and I expose their lies anyway. The war on medicine is real—COVID was just the beginning. Now they're rolling out mRNA tech for cancer, embedding AI in biotech, and pushing a transhumanist agenda that turns humans into lab rats. What's worse? They're gaslighting us, poisoning our food, manipulating our health, and calling it “science.” We break down why RFK Jr. is the man to finally dismantle this corrupt system, the lies behind the cancer industry, and why so many people are sick, infertile, and dying young. This is the medical-industrial complex's worst nightmare.Dr Pierre Kory and Jeff Dornik will both be speaking at the upcoming Summit for Truth & Wellness in Rochester, NY, on March 29th, alongside Mary Holland, Naomi Wolf, Dr Mary Talley Bowden and Shannon Joy. Get your tickets at https://summitfortruth.com.Follow Dr Pierre Kory on X: https://x.com/PierreKoryFollow Jeff Dornik on Pickax: https://pickax.com/jeffdornikFollow Maverick Broadcasting on Pickax: https://pickax.com/maverickbroadcastingPrepare for the next pandemic with the Contagion Emergency Kit from The Wellness Company, offering life-saving medications like Ivermectin, Hydroxychloroquine, Azithromycin, Oseltamivir, and Budesonide. Use code JEFF for 10% off and ensure you have the necessary tools and guidance at the ready. https://twc.health/jeff

On episode #74 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 1/30/25 – 2/12/25. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral Global Impact of mass vaccination campaigns on circulating type 2 vaccine-derived poliovirus outbreaks (JID) Co-infection of SARS‐CoV‐2 and influenza A/B among patients with COVID-19 (BMC Infectious Diseases) Oseltamivir reduces 30-Day mortality in older adults with Influenza (OFID) Bacterial Predicting benefit from adjuvant therapy with corticosteroids in community-acquired pneumonia (LANCET Respiratory Medicine) Rethinking antibiotic prophylaxis for spontaneous bacterial peritonitis in patients with cirrhosis (CID) Determining the optimal antibiotic duration for skin and soft tissue infections (Current Opinion in Infectious Diseases) The stealth and potentially fatal nature of Kingella kingae outbreaks in daycare facilities (OFID) Piperacillin/tazobactam vs. cefepime or carbapenems for the treatment of bloodstream infections due to bacteria producing chromosomal AmpC beta-lactamase (Infection) Is systemic dissemination of BCG following neonatal vaccination required for protection against Mycobacterium tuberculosis? (JID) Risk of aortic aneurysm or dissection following use of fluoroquinolones: a retrospective multinational network cohort study (eClinical Medicine) Fungal The Last of US Season 2 (YouTube) Developing mRNA lipid nanoparticle vaccine effective for cryptococcosisin a murine model (Vaccines) The araneopathogenic genus Gibellula (Cordycipitaceae: Hypocreales) in the British Isles, including a new zombie species on orb-weaving cave spiders (Metainae: Tetragnathidae) (Fungal Systematics and Evolution) Sensitivity of Coccidioides serologic tests among culture-proven coccidioidomycosis patients with hematological malignancy compared to a matched immunocompetent cohort (Medical Mycology) Parasitic New WHO guidelines for treating rhodesiense human African trypanosomiasis: expanded indications for fexinidazole and pentamidine (LANCET: Infectious Diseases) Miscellaneous Remote practice of infectious diseases through telemedicine (OFID) Telemedicine offers solutions for the rural disparities in infectious disease (ID) care delivery (OFID) Music is by Ronald Jenkees Information on this podcast should not be considered as medical advice.

VOV1 - Trước tâm lý sợ thuốc khan hiếm, giá thuốc điều trị cúm sẽ tăng, người dân đã đổ xô đi mua thuốc Tamiflu (chứa hoạt chất Oseltamivir) - thuốc kháng virus cúm A về dự trữ, Cục Quản lý Dược (Bộ Y tế) cho biết, các thuốc chứa hoạt chất Oseltamivir (Tamiflu) hiện vẫn đảm bảo về nguồn cung.

We have finally reached 100 of the top 200 drugs podcasts! On this episode, we tackle methadone. This is a complex opioid used for opioid use disorder and may also be used for pain. Enalapril is an ACE inhibitor that is used for hypertension. Cough and hyperkalemia are two major adverse effects to remember. Oseltamivir is a neuraminidase inhibitor. In patients with poor renal function, we need to make sure to adjust the dose accordingly. Ropinirole is a dopamine agonist. This medication is primarily used for restless leg syndrome but is also indicated for Parkinson's disease. Penicillin VK is the original penicillin antibiotic. Common indications of this medication are strep throat, skin and soft tissue infections, and syphilis.

So far, buying medicines in India has been a complete minefield. Allow me to elaborate with the help of a completely plausible hypothetical scenario. Say you catch the flu one day and need 75 mg of the antiviral drug Oseltamivir. More often than not, we don't really check the price tag of these drugs. But what if I told you the prices can swing anywhere between Rs 30 and Rs 125 per capsule, depending on the manufacturer and the doctor prescribing it. Now, variable pricing is not really a revelation. It's a pretty common practice. The government caps the price of nearly 400 essential drugs through the National List of Essential Medicines. But that's where the oevrsight ends. Generally, non-essential drugs remain outside this price cap. The National Health Authority, the body which runs India's public health insurance scheme, Ayushman Bharat, is now looking for digital pharmacy partners to promote pricing transparency. The aim is to tackle this overcharging crisis. So in September, it went ahead and enlisted Marg ERP, a leading provider of pharmacy inventory software as one such partner. Now Kaushal Shah, founder of Evitalrx, revealed that even his cloud-based pharma software firm is on track to join the initiative in the coming weeks.But here's the thing. This one click solution is still a long way off. Tune in. Don't forget to send us your recommendation for this Thursday's Unwind segment. The theme is “your favourite murder mystery.” Send them to us on WhatsApp as a voice note or as a text message. The number is +9189711-08379 Daybreak is produced from the newsroom of The Ken, India's first subscriber-only business news platform. Subscribe for more exclusive, deeply-reported, and analytical business stories.

In this episode of The Jeff Dornik Show, I got to sit down for an interview on What's Really Going On in America and we dove into the war over free speech, platforms like Pickax, and the absolute necessity of supporting those who share our values. We exposed how mainstream platforms like X and Facebook are actively censoring dissent while protecting anonymous troll farms from foreign actors that push divisive content. And this isn't just a problem for conservatives anymore—content creators from across the spectrum are seeing their income streams slashed thanks to Big Tech's manipulative algorithms. We can't win this battle by propping up the very companies trying to silence us. That's why Pickax is committed to being a real free speech platform—no censorship, no algorithms designed to bury the truth, and full monetization for creators who actually want to reach their audience. If you're tired of watching your voice get drowned out, it's time to ditch the enemy's platforms and join us at Pickax. Follow and Subscribe to Jeff Dornik on Pickax: https://jeffdornik.com/jeffdornik Follow and Subscribe to What's Really Going On In America on Pickax: https://pickax.com/wrgoa Prepare for the next pandemic with the Contagion Emergency Kit from The Wellness Company, offering life-saving medications like Ivermectin, Hydroxychloroquine, Azithromycin, Oseltamivir, and Budesonide. Use code JEFF for 10% off and ensure you have the necessary tools and guidance at the ready. https://twc.health/jeff

Contributor: Aaron Lessem MD Educational Pearls:  Oseltamivir (Tamiflu) is an antiviral medication used commonly to treat influenza Trials show that the medication reduces the duration of illness by less than 1 day (~16 hours in one systematic review) Benefit only occurs if taken within 48 hours of symptom onset Must be taken for 5 days A 2024 meta-analysis reviewed 15 randomized-controlled trials for the risk of hospitalization No reduction in hospitalizations with oseltamivir in patients over the age of 12 No difference in high-risk patients over the age of 65 or those with comorbidities The authors note that the confidence interval in these populations is wide, indicating a need for subsequent studies in high-risk populations Oseltamivir is associated with adverse effects including nausea, vomiting, and neurologic symptoms The risk of adverse effects may outweigh the benefits of a small reduction in the duration of illness References 1. Hanula R, Bortolussi-Courval É, Mendel A, Ward BJ, Lee TC, McDonald EG. Evaluation of Oseltamivir Used to Prevent Hospitalization in Outpatients with Influenza: A Systematic Review and Meta-Analysis. JAMA Intern Med. 2024;184(1):18-27. doi:10.1001/jamainternmed.2023.0699 2. Jefferson T, Jones M, Doshi P, Spencer EA, Onakpoya I, Heneghan CJ. Oseltamivir for influenza in adults and children: Systematic review of clinical study reports and summary of regulatory comments. BMJ. 2014;348(April):1-18. doi:10.1136/bmj.g2545 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit  

NanoViricides CEO Dr Anil Diwan joined Steve Darling from Proactive to share news to discuss the significant antiviral capabilities of NV-387. The company reports that NV-387 exhibits ultra-broad antiviral activity. NV-387's spectrum extends beyond combating COVID-19 and corona viruses to RSV and Influenza A viruses, including potentially the Bird Flu H5N1 virus. In comparative studies against approved anti-influenza drugs—Oseltamivir, Peramivir, and Baloxivir—NV-387 demonstrated superior antiviral effects. In a lethal lung infection model with the H3N2 strain, NV-387 treated mice showed a remarkable survival rate, significantly outperforming the traditional treatments and highlighting its potential as a more effective antiviral agent. NV-387 has also shown ffectiveness against the orthopoxvirus family through both inhalation and skin abrasion modes of infection acquisition. Notably, Ectromelia virus infection in mice, which is a model for Smallpox in humans and serves as a surrogate for MPox infection, has been successfully countered by NV-387. In a lethal animal model of lung infection by Ectromelia virus, oral administration of NV-387 significantly increased the lifespan of mice, showing comparable results to those treated with tecovirimat, the approved Smallpox drug. This positions NV-387 as a strong clinical candidate for treating poxvirus infections under the US FDA "Animal Rule." Additionally, combining NV-387 with tecovirimat may further enhance its effectiveness by reducing the potential for resistance development. This array of successful outcomes underscores NanoViricides' commitment to advancing antiviral therapy and enhancing public health defenses against a range of viral threats. #proactiveinvestors #nanoviricidesinc #nyseamerican #nnvc #biotec #DrAnilDiwan, #antiviral, #ENV387, #Phase1Trials, #Phase2Trials, #RSV, #coronavirus, #influenza, #smallpox, #clinicaltrials, #drugdevelopment, #healthcare, #medicalresearch, #pandemic, #FDA, #regulatoryapproval, #Tamiflu, #biopharma, #virology#invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews

Join us today as Gary, Kate, Mark and Henry discuss risks of SSRIs provoking mania in adolescents, real world effectiveness of HPV vaccination for preventing cervical cancer, whether tamiflu reduces hospitalization in adults with flu, and the effects of exercise on BP.

On episode #31 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 6/8 – 6/20/23. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of Puscast! Links for this episode Relative effectiveness of the cell-based quadrivalent influenza vaccine in preventing cardiorespiratory hospitalizations (OFID) Evaluation of Oseltamivir used to prevent hospitalization in outpatients with influenza (JAMA) Pan-ebolavirus monoclonal antibody cocktail provides protection against Ebola and Sudan viruses (JID) Inappropriate antibiotic prescribing and its determinants among outpatient children in low-and middle-income countries (PLOS) IDSA 2023 Guidance on the treatment of antimicrobial resistant gram-negative infections (IDSA) Evaluating antimicrobial duration for gram-negative bacteremia in patients with neutropenia (TID) Antibiotic myths for the ID clinician (CID) Dalbavancin for the treatment of acute bacterial skin and skin structure infection in patients with obesity or Diabetes (OFID) Global differences in the management of S. aureus bacteremia (CID) Clinical risk Scores to Predict Trimethoprim-Sulfamethoxazole, Fluoroquinolone, Nitrofurantoin, and Cephalosporin non-susceptibility among outpatient episodes of complicated UTI among adults (OFID) Continuous vs intermittent meropenem administration in critically ill patients with sepsis (JAMA) Current pyuria cutoffs promote inappropriate UTI diagnosis in older women (CID) Paenibacillus infection as a novel cause of sepsis in term neonates with high risk of sequelae in Uganda (CID) Antimicrobial for 7 or 14 Days for febrile urinary tract infection in men (CID) Candida auris‒associated hospitalizations (EID) Fatal invasive mold infections after transplantation of organs recovered from drowned donors (EID) Music is by Ronald Jenkees

In his weekly clinical update, Dr. Griffin discusses surveillance to track progress toward poliomyelitis eradication, genetic stabilization of attenuated oral vaccines against poliovirus types 1 and 3, evaluation of Oseltamivir used to prevent hospitalization in outpatients with Influenza, viral emissions into the air and environment after SARS-CoV-2 human challenge, has COVID-19 threatened routine childhood vaccination, successful treatment of persistent symptomatic COVID-19 infection with extended duration Nirmatrelvir/Ritonavir, anemia as a risk factor for disease progression in patients admitted for COVID-19, impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome, post-COVID condition in patients with inflammatory rheumatic diseases, outpatient treatment of COVID-19 and incidence of post-COVID-19 condition over 10 months, metformin reduces SARS-CoV-2 in a Phase 3 randomized placebo controlled clinical trial, persistent serum protein signatures define an inflammatory subcategory of long COVID, and the relevance of pacing strategies in managing symptoms of post-COVID-19 syndrome. Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode Surveillance to track progress toward poliomyelitis eradication (CDC) Genetic stabilization of attenuated oral vaccines against poliovirus types 1 and 3 (Nature) Evaluation of Oseltamivir to prevent hospitalization in outpatients with Influenza (JAMA) Viral emissions into air and environment after SARS-CoV-2 human challenge (The Lancet) Has COVID-19 threatened routine childhood vaccination (Health Affairs) Successful treatment of COVID-19 with extended duration Nirmatrelvir/Ritonavir (OFID) Anemia as a risk factor for disease progression in patients admitted for COVID-19 (Nature) Impact of fatigue as the determinant of functional limitations among patients with post-COVID-19 syndrome (BMJ) Post-COVID condition in patients with inflammatory rheumatic diseases (The Lancet) Outpatient treatment of COVID-19 and incidence of post-COVID-19 condition (The Lancet) Metformin reduces SARS-CoV-2 in a Phase 3 placebo controlled clinical trial (MedRxiv) Persistent serum protein define an inflammatory subcategory of long COVID (Nature) Relevance of pacing strategies in managing symptoms of post-COVID-19 syndrome (JTM) Contribute to our FIMRC fundraiser at PWB Letters read on TWiV 1016 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv

Date: February 27, 2023 Reference: Walsh PS, Schnadower D, Zhang Y, Ramgopal S, Shah SS, Wilson PM. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. JAMA Pediatr. 2022. Guest Skeptic: Dr. Marisu Rueda-Altez is a pediatric infectious disease fellow at Children's National Hospital in Washington, DC. She is also the […] The post SGEM #397: Give a Little Bit…of Oseltamivir to Pediatric Patients Admitted with Influenza first appeared on The Skeptics Guide to Emergency Medicine.

In this episode, Tracy Zivin-Tutela, MD, answers audience questions on how best to care for patients at high risk of complications due to influenza from a live virtual meeting series. This episode includes expert insights on:Emerging resistance patterns of currently used antiviralsGetting the flu vaccine after treatment with antiviralsUse of antivirals in patients who test positive for flu and COVID-19Techniques and over-the-counter therapies other than yearly vaccination to avoid severe complications due to the flu Avoiding dairy after receiving baloxavirInsurance coverage for antiviralsConsidering bacterial and viral coinfection in patients with lung diseaseRetreating high-risk patients with antivirals after another flu exposureCalculating flu ratesPresenter:Tracy Zivin-Tutela, MDAttending PhysicianDivision of Infectious DiseasesDepartment of MedicineLos Alamitos Medical Center, Fountain Valley Regional HospitalNew Brunswick, CaliforniaDaniel Zalinov, PA-CAtrium HealthCharlotte, North CarolinaLink to full program:https://bit.ly/3GMokRC

You are working at Clerkship General when you are called to the resuscitation bay for a 55yo M presenting in respiratory distress. Initial Vitals Temp 99.9 HR 110 RR 22 BP 122/82 O2 82% on BiPAP 10/5 100%FiO2 Critical Actions Correctly interpret CXR #1 (multifocal PNA) Correctly interpret CXR #2 (bilateral PNTX) Treat with Oseltamivir […]

No episódio de hoje do check-up semanal, o editor-chefe médico do portal PEBMED, Ronaldo Gismondi, traz novas noticias sobre a Covid-19, com informações sobre a aprovação da Coronavac em crianças de 6 a 17 anos e a produção da Astrazeneca feita 100% pela Fiocruz. Ainda no podcast, ouça também sobre nova diretriz de via área difícil, infecção urinária na gestação e doença mão, pé e boca Encerrando o episódio, confira sobre o uso de clortalidona em pacientes com doença renal crônica e o que precisa saber sobre oseltamivir na prática clínica. Aperta o play e ouça agora o episódio.

O Oseltamivir, muito conhecido como o famoso Tamiflu, voltou a ser tema presente em muitas conversas nas últimas semanas. O principal motivo foi o surto de Influenza que chegou com força em nosso país ainda no fim de 2021 e se somou a esta nova avalanche de Covid-19 e os O post Oseltamivir, o famoso Tamiflu apareceu primeiro em Medicina em Debate.

A alta de casos de gripe pelo país tem provocado um aumento na procura de remédios para tratar a doenças, entre eles o Oseltamivir, popularmente conhecido como Tamiflu. O remédio é prescrito para pacientes que apresentam Síndrome Gripal ou Síndrome Respiratória Aguda Grave, mas quais devem ser os cuidados com relação ao seu uso? Em entrevista à CBN Vitória, o médico infectologista Lauro Ferreira Pinto fala sobre o uso do medicamento. Ouça as explicações completas!

Effective influenza management during the COVID-19 pandemic requires a knowledge of emerging diagnostics, immunizations, and antiviral agents. The armamentarium for influenza treatment now includes multiple classes including neuraminidase inhibitors (eg, oseltamivir) and the polymerase acidic endonuclease inhibitor, baloxavir. In this podcast, Mary Knudtson, DNSc, NP, FAAN, asks questions from healthcare professionals to infectious disease expert, Michael G. Ison, MD, MS on timely, individualized influenza prevention and treatment. This activity is available for CE/CME credit. Claim your credit at pce.is/flu.

Influenza management continues to increase in complexity as new diagnostic, prevention, and treatment options emerge and the COVID-19 pandemic adds additional considerations. Antiviral therapies for influenza now include neuraminidase inhibitors (eg, oseltamivir) and baloxavir. In this podcast, Lawrence Herman, DMSc, MPA, PA-C, asks timely influenza questions from healthcare professionals to infectious disease expert, Tracy Zivin-Tutela, MD. This activity is available for CE/CME credit. Claim your credit at pce.is/flu.

Au Pharmascope, on est de plus en plus confiant que l’influenza ne se pointera pas le bout du nez cette année, mais on ne prend aucune chance! Dans ce 67ème épisode, Nicolas, Sébastien et Isabelle discutent du traitement de l’influenza. Les objectifs pour cet épisode sont: Décrire les objectifs de traitement de l’influenzaIdentifier les patients qui peuvent bénéficier d’un traitement de l’influenzaExpliquer les bénéfices et les risques des traitements antiviraux contre l’influenza Ressources pertinentes en lien avec l’épisode Revue systématique et méta-analyse portant sur les traitements antivirauxJefferson T et coll. Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database Syst Rev. 2014;2014:CD008965. Étude portant sur l’oseltamivirButler CC et coll. Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial. Lancet. 2020;395:42-52. Études CAPSTONE-1 et 2 portant sur le baloxavirHayden FG et coll. Baloxavir Marboxil for Uncomplicated Influenza in Adults and Adolescents. N Engl J Med. 2018;379:913-23. Ison MG et coll. Early treatment with baloxavir marboxil in high-risk adolescent and adult outpatients with uncomplicated influenza (CAPSTONE-2): a randomised, placebo-controlled, phase 3 trial. Lancet Infect Dis. 2020; 20:1204-14. Guide de l’INESSSInstitut national d’excellence en santé et en services sociaux. Guide d’usage optimal -  Traitement et prophylaxie de l’influenza chez l’enfant et l’adulte dans le contexte de la covid-19. Décembre 2020. Lignes directrices de l’IDSAUyeki TM et coll. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza. Clin Infect Dis. 2019;68:e1-47. Lignes directrices canadiennesAoki FY et coll. Use of antiviral drugs for seasonal influenza: Foundation document for practitioners - Update 2019. JAMMI. 2019;4:60-82. Rapports d’activité grippale au Canada (ÉpiGrippe)Gouvernement du Canada. Grippe (influenza): Surveillance ÉpiGrippe. 2020. Tableau comparatif des symptômes de l’influenza, de la COVID-19 et du rhumeAlberta Health Services. Disponible en ligne.

Date: December 16th, 2020 Reference: Butler et al. Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial. The Lancet 2020 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com. He has a great new blog post about how […]

This episode covers zanamivir and oseltamivir!

FDA 治疗高度耐药肺结核的新药NEJM 巴罗萨韦对流感家庭接触者的流感预防效果医学前沿 支气管低温冷冻术和支气管流变成形术治疗慢性支气管炎普托马尼（pretomanid）普托马尼（pretomanid）是一种新型的口服硝基咪唑嗪类抗菌药。2019年8月，普托马尼被批准作为BPaL方案（贝达喹啉、 普托马尼和利奈唑胺）和BPaMZ（贝达喹啉、 普托马尼、莫西沙星和吡嗪酰胺）方案的一部分用于治疗耐药性肺结核。《开放标签单组研究：高度耐药肺结核的治疗》New England Journal of Medicine，2020年3月 (1)这项开放标签、单组研究的目的是评价贝达喹啉、普托马尼和利奈唑胺联合26周治疗广泛耐药结核病患者、以及治疗无效或因副作用而停用二线治疗方案的多药耐药结核病患者的安全性和疗效。共计109例患者被纳入本研究，治疗结束后6个月时，90%的患者结局良好。11例不良结局包括：7例死亡，2例在随访期间复发。利奈唑胺的预期毒性作用包括周围神经病（81%）和骨髓抑制（48%），这些毒性作用虽然常见，但可以控制，常导致利奈唑胺减量或中断用药。结论：在高度耐药结核病患者中，在治疗结束后6个月时，贝达喹啉、普托马尼和利奈唑胺联合治疗使高比例的患者有良好结局。流行性感冒流行性感冒是甲型或乙型流感病毒导致的急性呼吸道疾病，在世界范围内引起爆发和流行，主要发生在冬季。患者出现上呼吸道和/或下呼吸道受累的症状，伴有全身症状，如发热（37.8°C-40.0°C）、头痛、肌痛和无力。一般人群中流感属于自限性疾病，高危人群中并发症和死亡率增加。流感通过大颗粒飞沫和小颗粒气溶胶传播，潜伏期1-4天，无并发症的患者病程持续1周左右，病毒排出时间为病毒暴露后0.5天到7天，病毒排出的高峰在第2天。高危人群包括：年龄≥65岁，妊娠或产后2周，住在长期护理机构，美国印第安人和阿拉斯加原住民，极端肥胖者（BMI≥40kg/m2)，慢性疾病患者，糖皮质激素或免疫抑制治疗的患者。《回顾观察性研究：老年人流感疫苗接种对住院和死亡率的影响》Annual of Internal Medicine，2020年4月 (2)65岁以上的老年人接种疫苗有临床获益的证据非常缺乏，研究者设计了一项“断点回归”分析，他们通过英国7个大型临床数据库分析了疫苗接种率和流感相关疾病。研究发现成人疫苗接种率在65岁这一年，从34%提高至57%。重度呼吸系统疾病均随着年龄的增长而升高，平滑地通过了65岁这一门槛，没有出现急剧下降。假如每年接种流感疫苗的确能给65岁以上的老年人带来明显临床益处的话，预期应出现急剧下降。结论：老年人接种流感疫苗充其量只有很小的直接获益。《双盲随机对照研究：巴罗萨韦对流感家庭接触者的流感预防效果》New England Journal of Medicine，2020年7月 (3)巴罗萨韦在家庭环境中的暴露后预防效果尚不明确。这项多中心、双盲、随机、安慰剂对照试验，在确诊流感病例的545个家庭的752个接触者中，将参与者随机分为两组，分别接受巴罗萨韦或安慰剂单剂给药。巴罗萨韦预防组患临床流感显著低于安慰剂组（1.9% vs. 13.6%；P＜0.001）。巴罗萨韦在高危、儿童和未接种疫苗的参与者的亚组中有效。两组的不良事件发生率相似（巴洛沙韦组22.2%和安慰剂组20.5%）。结论：单剂巴罗萨韦显示出显著的流感病毒暴露后预防效果。流行性感冒的治疗抗病毒治疗包括：神经氨酸酶抑制剂（奥司他韦、扎那米韦和帕拉米韦），流感病毒cap-依赖性核酸内切酶选择性抑制剂巴罗萨韦（baloxavir），金刚烷胺类（金刚烷胺和金刚乙胺）。《开放标签随机对照研究：流感样疾病的治疗中加用奥司他韦的疗效研究》Lancet，2020年1月 (4)研究目的是确定流感样疾病患者在常规初级护理中加入奥司他韦抗病毒治疗是否会缩短康复时间。这项开放标签的、实用的、适应性的、随机对照试验中，将奥司他韦添加到常规治疗中。研究纳入3266名参与者，其中52%经证实感染了流感。总体而言，奥司他韦组的患者恢复时间较短，绝对缩短1.20天。对于没有合并症的、

FDA 治疗高度耐药肺结核的新药NEJM 巴罗萨韦对流感家庭接触者的流感预防效果医学前沿 支气管低温冷冻术和支气管流变成形术治疗慢性支气管炎普托马尼（pretomanid）普托马尼（pretomanid）是一种新型的口服硝基咪唑嗪类抗菌药。2019年8月，普托马尼被批准作为BPaL方案（贝达喹啉、 普托马尼和利奈唑胺）和BPaMZ（贝达喹啉、 普托马尼、莫西沙星和吡嗪酰胺）方案的一部分用于治疗耐药性肺结核。《开放标签单组研究：高度耐药肺结核的治疗》New England Journal of Medicine，2020年3月 (1)这项开放标签、单组研究的目的是评价贝达喹啉、普托马尼和利奈唑胺联合26周治疗广泛耐药结核病患者、以及治疗无效或因副作用而停用二线治疗方案的多药耐药结核病患者的安全性和疗效。共计109例患者被纳入本研究，治疗结束后6个月时，90%的患者结局良好。11例不良结局包括：7例死亡，2例在随访期间复发。利奈唑胺的预期毒性作用包括周围神经病（81%）和骨髓抑制（48%），这些毒性作用虽然常见，但可以控制，常导致利奈唑胺减量或中断用药。结论：在高度耐药结核病患者中，在治疗结束后6个月时，贝达喹啉、普托马尼和利奈唑胺联合治疗使高比例的患者有良好结局。流行性感冒流行性感冒是甲型或乙型流感病毒导致的急性呼吸道疾病，在世界范围内引起爆发和流行，主要发生在冬季。患者出现上呼吸道和/或下呼吸道受累的症状，伴有全身症状，如发热（37.8°C-40.0°C）、头痛、肌痛和无力。一般人群中流感属于自限性疾病，高危人群中并发症和死亡率增加。流感通过大颗粒飞沫和小颗粒气溶胶传播，潜伏期1-4天，无并发症的患者病程持续1周左右，病毒排出时间为病毒暴露后0.5天到7天，病毒排出的高峰在第2天。高危人群包括：年龄≥65岁，妊娠或产后2周，住在长期护理机构，美国印第安人和阿拉斯加原住民，极端肥胖者（BMI≥40kg/m2)，慢性疾病患者，糖皮质激素或免疫抑制治疗的患者。《回顾观察性研究：老年人流感疫苗接种对住院和死亡率的影响》Annual of Internal Medicine，2020年4月 (2)65岁以上的老年人接种疫苗有临床获益的证据非常缺乏，研究者设计了一项“断点回归”分析，他们通过英国7个大型临床数据库分析了疫苗接种率和流感相关疾病。研究发现成人疫苗接种率在65岁这一年，从34%提高至57%。重度呼吸系统疾病均随着年龄的增长而升高，平滑地通过了65岁这一门槛，没有出现急剧下降。假如每年接种流感疫苗的确能给65岁以上的老年人带来明显临床益处的话，预期应出现急剧下降。结论：老年人接种流感疫苗充其量只有很小的直接获益。《双盲随机对照研究：巴罗萨韦对流感家庭接触者的流感预防效果》New England Journal of Medicine，2020年7月 (3)巴罗萨韦在家庭环境中的暴露后预防效果尚不明确。这项多中心、双盲、随机、安慰剂对照试验，在确诊流感病例的545个家庭的752个接触者中，将参与者随机分为两组，分别接受巴罗萨韦或安慰剂单剂给药。巴罗萨韦预防组患临床流感显著低于安慰剂组（1.9% vs. 13.6%；P＜0.001）。巴罗萨韦在高危、儿童和未接种疫苗的参与者的亚组中有效。两组的不良事件发生率相似（巴洛沙韦组22.2%和安慰剂组20.5%）。结论：单剂巴罗萨韦显示出显著的流感病毒暴露后预防效果。流行性感冒的治疗抗病毒治疗包括：神经氨酸酶抑制剂（奥司他韦、扎那米韦和帕拉米韦），流感病毒cap-依赖性核酸内切酶选择性抑制剂巴罗萨韦（baloxavir），金刚烷胺类（金刚烷胺和金刚乙胺）。《开放标签随机对照研究：流感样疾病的治疗中加用奥司他韦的疗效研究》Lancet，2020年1月 (4)研究目的是确定流感样疾病患者在常规初级护理中加入奥司他韦抗病毒治疗是否会缩短康复时间。这项开放标签的、实用的、适应性的、随机对照试验中，将奥司他韦添加到常规治疗中。研究纳入3266名参与者，其中52%经证实感染了流感。总体而言，奥司他韦组的患者恢复时间较短，绝对缩短1.20天。对于没有合并症的、

Algum caso de síndrome gripal já te deixou na dúvida sobre a indicação ou não de oseltamivir? Não sabe quais desfechos são prevenidos? Posso começar após 48h de sintomas? Esses e outros pontos no podcast da semana.

En este capitulo nos centraremos en el Oseltamivir, un fármaco que combate al virus de la influenza, explicaremos qué son y cómo funcionas las enzimas, al igual que indagaremos un poco más sobre las cualidades del virus y el tratamiento de esta enfermedad.

Dr. Ebell and Dr. Wilkes discuss the POEM titled ' Pragmatic trial: Oseltamivir of uncertain benefit in patients with flu-like symptoms '

I know there are a lot of concerns regarding this current virus that have devastated many families, multiple states and not excluding countries. I am inviting you to listen to this and share with your friends and family. In the meantime, let's also share some good news. Someone shared the following and I thought it was perfect for this post. Let's talk some GOOD NEWS, shall we? It's reported that: China has closed down its last coronavirus hospital. Not enough new cases to support them. Doctors in India have been successful in treating Coronavirus. Combination of drugs used: Lopinavir, Retonovir, Oseltamivir along with Chlorphenamine. They are going to suggest same medicine, globally. Researchers of the Erasmus Medical Center claim to have found an antibody against coronavirus. A 103-year-old Chinese grandmother has made a full recovery from COVID-19 after being treated for 6 days in Wuhan, China. Apple reopens all 42 china stores. Cleveland Clinic developed a COVID-19 test that gives results in hours, not days. Good news from South Korea, where the number of new cases is declining. Italy is hit hard, experts say, only because they have the oldest population in Europe. Scientists in Israel likely to announce the development of a coronavirus vaccine. A network of Canadian scientists are making excellent progress in Covid-19 research. A San Diego biotech company is developing a Covid-19 vaccine in collaboration with Duke University and National University of Singapore. Plasma from newly recovered patients from Covid -19 can treat others infected by Covid-19. So it's not ALL bad news. Let's care for each other and stay focused on safety of those most vulnerable. Focus on the positive, there are more alive than otherwise. SistaQueen. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Dr. Megan A. Rech discusses the risks and benefits of making Tamiflu available without a prescription. Manuscript: https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.2370

Episode 39 is here! Today Zach and LJ discuss whether we should always be doing CPR in the very elderly, then they talk about a new Tamiflu study and if this drug is really valuable, and finally they take on the patient room Whiteboard. If you've got a question or comment for us, send us an email at chiefcomplaintpod@gmail.com, tweet us @ChiefPod, or find us on Instagram @ChiefComplaintPodcast. See you next week for a brand new episode!Links:CPR, By Default: https://www.nytimes.com/2020/01/31/health/cpr-elderly.htmlTamiflu: https://first10em.com/tamiflu-doesnt-work/Whiteboards: https://www.journalofhospitalmedicine.com/jhospmed/article/127377/patient-whiteboards-hospital-settingMusic:You're There by The Mini VandalsAll Night by IksonNews Sting by Kevin McCleod (incompetech.com)

Bei Influenza: Drei Tage schneller fit. LANCET https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32982-4/fulltext RKI https://influenza.rki.de Dieser Podcast-Service wird ihnen ermöglicht mit freundlicher Unterstützung von Bronchipret® Mehr Informationen zum Podcast unter: https://www.medical-tribune.de/news/medaudio-der-podcast-von-aerzten-fuer-aerzte/

What is the link between midlife obesity and future dementia risk? Find out about this and more in today's PV Roundup podcast.

Oseltamivir is an antiviral agent that is indicated for the treatment and prophylaxis of influenza. It is important to remember that oseltamivir is cleared at least in part by the kidney and dose adjustments should be made based upon kidney function. There is a low potential that oseltamivir could contribute to psych issues like delirium. Probenecid has the potential to raise the concentrations of oseltamivir.

Drs. Stanton and Sarlin agree that Tamiflu just isn’t worth it for most patients. Listen in as they talk about whether it makes sense to get the vaccine once you get the flu, what to tell patients about avoiding the flu in the first place, and how oseltamivir was resurrected from the dead.

Author: Aaron Lessen, MD Educational Pearls: Recent meta-analysis reviewed efficacy oseltamivir (Tamiflu) in pediatric populations treated for influenza, showing an 18 hour reduction in duration of illness for those with laboratory confirmed influenza Those with suspected influenza unsurprisingly had less effect Subgroup analysis showed most benefit in those treated within the first 24 hours of symptom onset Patients with confirmed influenza treated with oseltamivir had a 34% reduction in risk of otitis media Editor’s note:  Vomiting was higher in the treatment groups; There were no significantly different outcomes in regards to other endpoints, such as lower respiratory tract infections and hospitalizations References: Malosh RE, Martin ET, Heikkinen T, Brooks WA, Whitley RJ, Monto AS. Efficacy and Safety of Oseltamivir in Children: Systematic Review and Individual Patient Data Meta-analysis of Randomized Controlled Trials. Clin Infect Dis. 2018 May 2;66(10):1492-1500. doi: 10.1093/cid/cix1040. PubMed PMID: 29186364. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

  Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re talking about a topic that is ripe for review this time of year. We’re talking Influenza… Diagnosis and Management. Nachi: Very appropriate as the cold is settling in here in NYC and we’re already starting to see more cases of influenza. Remember that as you listen through the episode, the means we’re about to cover one of the CME questions for those of you listening at home with the print issue handy. Jeff: This month’s issue was authored by Dr. Al Giwa of the Icahn School of Medicine at Mount Sinai, Dr. Chinwe Ogedegbe of the Seton Hall School of Medicine, and Dr. Charles Murphy of Metrowest Medical Center. Nachi: And this issue was peer reviewed by Dr. Michael Abraham of the University of Maryland School of Medicine and by Dr. Dan Egan, Vice Chair of Education of the Department of Emergency Medicine at Columbia University. Jeff: The information contained in this article comes from articles found on pubmed, the cochrane database, center for disease control, and the world health organization. I’d say that’s a pretty reputable group of sources. Additionally, guidelines were reviewed from the american college of emergency physicians, infectious disease society of america, and the american academy of pediatrics. Nachi: Some brief history here to get us started -- did you know that in 1918/1919, during the influenza pandemic, about one third of the world’s population was infected with influenza? Jeff: That’s wild. How do they even know that? Nachi: Not sure, but also worth noting -- an estimated 50 million people died during that pandemic. Jeff: Clearly a deadly disease. Sadly, that wasn’t the last major outbreak… fifty years later the 1968 hong kong influenza pandemic, H3N2, took between 1 and 4 million lives. Nachi: And just last year we saw the 2017-2018 influenza epidemic with record-breaking ED visits. This was the deadliest season since 1976 with at least 80,000 deaths. Jeff: The reason for this is multifactorial. The combination of particularly mutagenic strains causing low vaccine effectiveness, along with decreased production of IV fluids and antiviral medication because of the hurricane, all played a role in last winter’s disastrous epidemic. Nachi: Overall we’re looking at a rise in influenza related deaths with over 30,000 deaths annually in the US attributed to influenza in recent years. The ED plays a key role in outbreaks, since containment relies on early and rapid identification and treatment. Jeff: In addition to the mortality you just cited, influenza also causes a tremendous strain on society. The CDC estimates that epidemics cost 10 billion dollars per year. They also estimate that an epidemic is responsible for 3 million hospitalized days and 31 million outpatient visits each year. Nachi: It is thought that up to 20% of the US population has been infected with influenza in the winter months, disproportionately hitting the young and elderly. Deaths from influenza have been increasing over the last 20 years, likely in part due to a growing elderly population. Jeff: And naturally, the deaths that we see from influenza also disproportionately affect the elderly, with up to 90% occurring in those 65 or older. Nachi: Though most of our listeners probably know the difference between an influenza epidemic and pandemic, let’s review it anyway. When the number of cases of influenza is higher than what would be expected in a region, an epidemic is declared. When the occurrence of disease is on a worldwide spectrum, the term pandemic is used. Jeff: I think that’s enough epidemiology for now. Let’s get started with the basics of the influenza virus. Influenza is spread primarily through direct person-to-person contact via expelled respiratory secretions. It is most active in the winter months, but can be seen year-round. Nachi: The influenza virus is a spherical RNA-based virus of the orthomyxoviridae family. The RNA core is associated with a nucleoprotein antigen. Variations of this antigen have led to the the 3 primary subgroups -- influenza A, B, and C, with influenza A being the most common. Jeff: Influenza B is less frequent, but is more frequently associated with epidemics. And Influenza C is the form least likely to infect humans -- it is also milder than both influenza A or B. Nachi: But back to Influenza A - it can be further classified based on its transmembrane or surface proteins, hemagglutinin and neuraminidase - or H and N for short. There are actually 16 different H subtypes and 9 different N subtypes, but only H1, H2, H3, and N1 and N2 have caused epidemic disease. Jeff: Two terms worth learning here are antigen drift and anitgen shift. Antigen drift refers to small point mutations to the viral genes that code for H and N. Antigen shift is a much more radical change, with reassortment of viral genes. When cells are infected by 2 or more strains, a new strain can emerge after genetic reassortment. Nachi: With antigen shift, some immunity may be maintained within a population infected by a similar subtype previously. With antigen drift, there is loss of immunity from prior infection. Jeff: The appearance of new strains of influenza typically involves an animal host, like pigs, horses, or birds. This is why you might be hear a strain called “swine flu”, “equine flu”, or “avian flu”. Close proximity with these animals facilitates co-infection and genetic reassortment. Nachi: I think that’s enough basic biology for now, let’s move on to pathophysiology. When inhaled, the influenza virus initially infects the epithelium of the upper respiratory tract and alveolar cells of the lower respiratory tract. Viral replication occurs within 4 to 6 hours. Incubation is 18 to 72 hours. Viral shedding is usually complete roughly 7 days after infection, but can be longer in children and immunocompromised patients. Jeff: As part of the infectious process and response, there can be significant changes to the respiratory tract with inflammation and epithelial cell necrosis. This can lead to viral pneumonia, and occasionally secondary bacterial pneumonia. Nachi: The secondary bacterial pathogens that are most common include Staph aureus, Strep pneumoniae, and H influenzae. Jeff: Despite anything you may read on the internet, vaccines work and luckily influenza happens to be a pathogen which we can vaccinate against. As such, there are 3 methods approved by the FDA for producing influenza vaccines -- egg-based, cell-based, or recombinant influenza vaccine. Once the season’s most likely strains have been determined, the virus is introduced into the medium and allowed to replicate. The antigen is then purified and used to make an injection or nasal spray. Nachi: It isn’t easy to create vaccines for all strains. H3N2, for example, is particularly virulent, volatile, and mutagenic, which leads to poor prophylaxis against this particular subgroup. Jeff: In fact, a meta-analysis on vaccine effectiveness from 2004-2015 found that the pooled effectiveness against influenza B was 54%, against the H1N1 pandemic in 2009 was 61%, and against the H3N2 virus was 33%. Not surprisingly, H3N2 dominant seasons are currently associated with the highest rates of influenza cases, hospitalizations, and death. Nachi: Those are overall some low percentages. So should we still be getting vaccinated? The answer is certainly a resounding YES.. Despite poor protection from certain strains, vaccine effectiveness is still around 50% and prevents severe morbidity and mortality in those patients. Jeff: That’s right. The 2017-2018 vaccine was only 40% effective, but this still translates to 40% less severe cases and a subsequent decrease in hospitalizations and death. Nachi: But before we get into actual hospitalization, treatment, and preventing death, let’s talk about the differential. We’re not just focusing on influenza here, but any influenza like illness, since they can be hard to distinguish. The CDC defines “influenza-like illness” as a temperature > 100 F, plus cough or sore throat, in the absence of a known cause other than influenza. Jeff: Therefore, influenza should really be considered on the differential of any patient who presents to the ED with a fever and URI symptoms. The differential when considering influenza might also include mycoplasma pneumoniae, strep pneumoniae, adenovirus, RSV, rhinovirus, parainfluenza virus, legionella, and community acquired MRSA. Nachi: With the differential in mind, let’s move on to prehospital care. For the prehospital setting, there isn’t much surprising here. Stabilize and manage the respiratory status with all of your standard tools - oxygen for those with mild hypoxia and advanced airway maneuvers for those with respiratory distess. Jeff: Of note, EMS providers should use face masks themselves and place them on patients as well. As community paramedicine and mobile integrated health becomes more common, this is one potential area where EMS can potentially keep patients at home or help them seek treatment in alternate destinations to avoid subjecting crowded ED’s to the highly contagious influenza virus. Nachi: It’s also worth noting, that most communities have strategic plans in the event of a major influenza outbreak. Local, state, and federal protocols have been designed for effective care delivery. Jeff: Alright, so now that the EMS crew, wearing proper PPE of course, has delivered the patient, who is also wearing a mask, to the ED, we can begin our ED H&P. Don’t forget that patients present with a range of symptoms that vary by age. A typical history is 2-5 days of fever, nasal congestion, sore throat, and myalgias. You might see tachycardia, cough, dyspnea, and chills too. Nachi: Van Wormer et al conducted a prospective analysis of subjective symptoms to determine correlation with lab confirmed influenza. They found the most common symptoms were cough in 92%, fatigue in 91%, and nasal congestion in 84%, whereas sneezing was actually a negative predictor for influenza. Jeff: Sneezing, really? Can’t wait to get the Press-Gany results from the sneezing patient I discharge without testing for influenza based on their aggressive sneezes! Nachi: Aggressive sneezes…? I can’t wait to see your scale for that. Jeff: Hopefully I’ll have it in next month’s annals. In all seriousness, I’m not doing away with flu swabs just yet. In another retrospective study, Monto et al found that the best multivariate predictors were cough and fever with a positive predictive value of 79%. Nachi: Yet another study in children found that the predominant symptoms were fever in 95%, cough in 77%, and rhinitis in 78%. This study also suggested that the range of fever was higher in children and that GI symptoms like vomiting and diarrhea were more common in children than adults. Jeff: Aside from symptomatology, there are quite a few diagnostic tests to consider including viral culture, immunofluoresence, rt-pcr, and rapid antigen testing. The reliability of testing varies greatly depending on the type of test, quality of the sample, and the lab. During a true epidemic, formal testing might not be indicated as the decision to treat is based on treatment criteria like age, comorbidities, and severity of illness. Nachi: We’ll get to treatment in a few minutes, but diving a bit deeper into testing - there are 3 major categories of tests. The first detects influenza A only. The second detects either A or B, but cannot distinguish between them; and the third detects both influenza A and B and is subtype specific. The majority of rapid testing kits will distinguish between influenza A and B, but not all can distinguish between them. Fluorescent antibody testing by DFA is relatively rapid and yields results within 2 to 4 hours. Jeff: Viral culture and RT-PCR remain the gold standard, but both require more time and money, as well as a specialized lab. As a result, rapid testing modalities are recommended. Multiple studies have shown significant benefit to the usefulness of positive results on rapid testing. It’s safe to say that at a minimum, rapid testing helps decrease delays in treatment and management. Nachi: Looking a bit further into the testing characteristics, don’t forget that the positive predictive value of testing is affected by the prevalence of influenza. In periods of low influenza activity (as in the summer), a rapid test will have low PPV and high NPV. The test is more likely to yield false positive results -- up to 50% according to one study when prevalence is below 5%. Jeff: And conversely, in periods of high influenza activity, a rapid test will have higher PPV and lower NPV, and it is more likely to produce a false negative result. Nachi: In one prospective study of patients who presented with influenza-like illness during peak season, rapid testing was found to be no better than clinical judgement. During these times, it’s probably better to reserve testing for extremely ill patients in whom diagnostic closure is particularly important. And since the quality of the specimen remains important, empiric treatment of critically ill patients should still be considered. Jeff: Which is a perfect segway into our next topic - treatment, which is certainly the most interesting section of this article. To start off -- for mild to moderate disease and no underlying high risk conditions, supportive therapy is usually sufficient. Nachi: Antiviral therapy is reserved for those with a predicted severe disease course or with high risk conditions like long-standing pulmonary disease, pregnancy, immunocompromise, or even just being elderly. Jeff: Note to self, avoid being elderly. Nachi: Good luck with that. Anyway, early treatment with antivirals has been shown to reduce influenza-related complications in both children and adults. Jeff: Once you’ve decided to treat the patient, there are two primary classes of antivirals -- adamantane derivatives and neuraminidase inhibitors. Oh and then there is a new single dose oral antiviral that was just approved by the FDA… baloxavir marboxil (or xofluza), which is in a class of its own -- a polymerase endonuclease inhibitor. Nachi: The oldest class, the adamantane derivatives, includes amantadine and rimantadine. Then the newer class of neuraminidase inhibitors includes oseltamavir (which is taken by mouth), zanamavir (which is inhaled), and peramivir (which is administered by IV). Jeff: Oseltamavir is currently approved for patients of all ages. A 2015 meta analysis showed that the intention-to-treat infected population had a shorter time to alleviation of all symptoms from 123 hours to 98 hours. That’s over a day less of symptoms, not bad! There were also fewer lower respiratory tract complications requiring antibiotics and fewer admissions for any cause. Really, not bad! Nachi: Zanamavir is approved for patients 7 and older -- or for children 5 or older for disease prevention. Zanamavir has been associated with possible bronchospasm and is contraindicated in patients with reactive airway disease. Jeff: Peramivir, the newest drug in this class, is given as a single IV dose for patients with uncomplicated influenza who have been sick for 2 days or less. Peramavir is approved for patients 2 or older. This is a particularly great choice for a vomiting patient. Nachi: And as you mentioned before, just last month, the FDA approved baloxavir, a single dose antiviral. It’s effective for influenza type A or B. Note that safety and efficacy have not been established for patients less than 12 years old, weighing less than 40 kg, or pregnant or lactating patients. Jeff: Unfortunately, there has been some pretty notable antiviral resistance in the recent past, moreso with the adamantane class, but recently also with the neuraminidase inhibitors. In 2007-2008, an oseltamivir-resistant H1N1 strain emerged globally. Luckily, cross-resistance between baloxavir and the adamantanes or neuraminidase inhibitors isn’t expected, as they target different viral proteins, so this may be an answer this year, and in the future. Nachi: Let’s talk chemoprophylaxis for influenza.. Chemoprophylaxis with oseltamavir or zanamavir can be considered for patients who are at high risk for complications and were exposed to influenza in the first 2 weeks following vaccination, patients who are at high risk for complications and cannot receive the vaccination, and those who are immunocompromised. Jeff: Chemoprophylaxis is also recommended for pregnant women. For postexposure prophylaxis for pregnant women, the current recommendation is to administer oseltamivir. Nachi: We should also discuss the efficacy of treatment with antivirals. This has been a hotly debated topic, especially with regards to cost versus benefit… In a meta-analysis, using time to alleviation of symptoms as the primary endpoint, oseltamavir resulted in an efficacy of 73% (with a wide 95% CI from 33% to 89%). And this was with dose of 150mg/day in a symptomatic influenza patient. Jeff: Similarly zanamavir given at 10mg/day was 62% effective, but again with a wide 95% CI from 15% to 83%. And, of note, other studies have looked into peramivir, but have found no significant benefits other than the route of delivery. Nachi: In another 2014 study by Muthuri et al., neuraminidase inhibitors were associated with a reduction in mortality -- adjusted OR = 0.81 (with a 95% CI 0.70 to 0.93). Also when comparing late treatment with early treatment (that is, within 2 days of symptom onset), there was a reduction in mortality risk with adjusted OR 0.48 (95%CI 0.41-0.56). These associations with reduction in mortality risk were less pronounced and less significant in children. Jeff: Mortality benefit, not bad! They further found an increase in mortality hazard ratio with each day’s delay in initiation of treatment up to 5 days, when compared to treatment initiated within 2 days. Nachi: But back to the children for a second -- another review of neuraminidase inhibitors in children < 12 years old found duration of clinical symptoms was reduced by 36 hours among previously healthy children taking oseltamivir and 30 hours by children taking zanamivir. Jeff: I think that’s worth summarizing - According to this month’s author’s review of the best current evidence, use of neuraminidase inhibitors is recommended, especially if started within 2 days, for elderly patients and those with comorbidities. Nachi: Seems like there is decent data to support that conclusion. But let’s not forget that these medications all have side effects. Jeff: These drugs actually tend to be well tolerated.The most frequently noted side effect of oseltamavir is nausea and vomiting, while zanamavir is associated with diarrhea. Nachi: Amazing. Let’s talk disposition for your influenza patient. Jeff: Disposition will depend on many clinical factors, like age, respiratory status, oxygen saturation, comorbid conditions, and reliability of follow up care. Admission might be needed not only to manage the viral infection, but also expected complications. Nachi: If you’re discharging a patient, be sure to engage in shared decision making regarding risks and benefits of available treatments. Ensure outpatient follow up and discuss return to er precautions. Jeff: Also, the CDC recommends that these patients stay home for at least 24 hours after their fever has broken. Nachi: With that -- Let’s summarize the key points and clinical pearls from this month’s issue J: Even though influenza vaccine effectiveness is typically only 50%, this still translates to a decrease in influenza-related morbidity and mortality. 2. The CDC defines influenza-like illness as a temperature > 100 F with either cough or sore throat, in the absence of a known cause other than influenza. 3. When influenza is suspected in the prehospital setting, patients and providers should wear face masks to avoid spreading the virus. 4. In the emergency department, standard isolation and droplet precautions should be maintained for suspected or confirmed infections. 5. The most common symptoms of influenza in adults are cough, fatigue, nasal congestion, and fever. Sneezing is a negative predictor in adults. 6. In children, the most common presenting symptoms are fever, cough, and rhinitis. Vomiting and diarrhea is also more common in children than adults. 7. Rapid testing and identification results in decreased delays in treatment and management decisions. 8. During peak flu season, clinical judgement may be as good as rapid testing, making rapid testing less necessary. J: Rapid testing may be more beneficial in times of lower disease prevalence. 10. Empiric treatment of critically ill patients should be considered even if rapid testing is negative. J: For mild to moderate disease and no underlying high-risk conditions, supportive therapy is usually sufficient. 12.For more ill patients or those at substantial risk for complications, consider antiviral treatment. 13.Oseltamivir is approved for patients of all ages, and reduces the length of symptoms by one day. 14.When treating influenza, peramivir is an ideal agent for the vomiting patient. 15.Baloxavir is a new single-dose antiviral agent approved by the FDA in October 2018. It works in a novel way and is effective for treatment of influenza A and B. 16.Chemoprophylaxis with oseltamivir or zanamivir should be considered in patients who are immunocompromised or patients who are at elevated risk for complications and cannot receive the vaccination. 17.Consider oseltamivir as post exposure prophylaxis in pregnant women. 18.Neuraminidase inhibitors are associated with decreased duration of symptoms and complications, especially if started within 2 days of symptom onset. J: So that wraps up episode 23 - Influenza: Diagnosis and Management in the Emergency Department. N: Additional materials are available on our website for Emergency Medicine Practice subscribers. For our subscribers: be sure to go online to get your CME credit for this issue, which includes 3 pharmacology CME credits. J: Also, for our NP and PA listeners, we have a special offer this month: You can get a full year of access to Emergency Medicine Practice for just $199--including lots of pharmacology, stroke, and trauma CME--and so much more! To get this special deal, go to www.ebmedicine.net/APP. Again, that’s www.ebmedicine.net/APP. N: If you’re not a subscriber, consider joining today. You can find out more at www.ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credits. You’ll also get enhanced access to the podcast, including the images and tables mentioned. You can find everything you need to know at ebmedicine.net/subscribe. J: And the address for this month’s credit is ebmedicine.net/E1218. As always, the you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at emplify@ebmedicine.net with any comments or suggestions. Talk to you next month!    

Single-dose influenza drug baloxavirhas similar efficacy to oseltamivir, according to new data in the New England Journal of Medicine. Also today, the relationship between obstructive sleep apnea and gout, community-based therapy for asthma in African American teens, and the importance of hospital settings for pneumonia.

Course: Flu vaccine update and Oseltamivir discussion Course Director: Tony R Tarchichi M.D.  - Assistant Professor in Dept of Pediatrics Course Director: John Williams M.D. - Professor in Dept of Pediatrics   Disclosures: None   This Podcast series was created for Pediatric Hospitalists or those healthcare professionals who take care of hospitalized children.    This episode is on Flu vaccine update and Oseltamivir discussion. As always there is free CME credit of up to 1 AMA category 1 for listening to this podcast and going to the Univ of Pitt site. See the link below.      _______________________________________________________________ Objectives: Upon completion of this activity, participants will be able to: Discuss this year’s flu vaccine and how effective it is. Discuss Oseltamivir and review the literature on its effectiveness against the flu virus Review the CDC recommendations regarding Oseltamivir usage in pediatrics. • Released:  12/23/2017,   Reviewed 12/23/2017, Expire: 12/23/2018   If you are new to the Internet-based Studies in Education and Research (ISER) website (which is how you will get your CME credit), you will first need to create an account:   Step 1. Create an Account https://www.hsconnect.pitt.edu/HSC/home/create-account.do   If you have used the ISER website in the past, you can click on the link below and then log onto in order to complete the evaluation for this training:   Step 2. To access the test for CME credit: https://cme.hs.pitt.edu/ISER/servlet/IteachControllerServlet?actiontotake=loadmodule&moduleid=18393   Accreditation Statement: The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.   The University of Pittsburgh School of Medicine designates this enduring material for a maximum of  (1)  AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

El programa de esta semana es variado. Empezamos por discutir las implicaciones de la bacteriemia por bacilos Gram-negativos resistentes en pacientes con trasplantes de medula ósea. Posteriormente comentamos un articulo sobre el tiempo apropiado de tratamiento en bacteriemia por bacilos Gram-negativos. También comentamos los beneficios del tratamiento combinado vs. el tratamiento simple con oseltamivir en la infección por Influenza. Finalmente hablamos sobre neumonía adquirida en la comunidad, sobre fosfomicina, y nitrofurantoina.   Referencias:   Diana Averbuch y colaboradores. Antimicrobial Resistance in Gram-Negative Rods Causing Bacteremia in Hematopoietic Stem Cell Transplant Recipients: Intercontinental Prospective Study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group. Clin Infect Diseases 2017.   Julio A. Ramirez y colaboradores. Adults Hospitalized with Pneumonia in the United States: Incidence, Epidemiology, and Mortality. Clin Infect Dis 2017.   Darunee Chotiprasitsakul  y colaboradores Comparing the Outcomes of Adults With  Enterobacteriaceae Bacteremia Receiving Short-Course  Versus Prolonged-Course Antibiotic therapy in a  Multicenter, Propensity Score–Matched Cohort . Clin Infect Dis 2017   John H Beigel y colaboradores. Oseltamivir, amantadine, and ribavirin combination antiviral therapy versus oseltamivir monotherapy for the treatment of influenza: a multicentre, double-blind, randomised phase 2 trial. Lancet Infect Dis. Dec 2017.   Fiona Fransen y colaboradores. Pharmacodynamics of fosfomycin against ESBL- and/or carbapenemase-producing Enterobacteriaceae. J Antimicrob Chemother. Dec 2017.   Fiona Fransen y colaboradores.  Pharmacodynamics of nitrofurantoin at different pH levels against pathogens involved in urinary tract infections. J Antimicrob Chemother. December 2007     La Frase de la Semana:  La tomamos del poeta Chileno Pablo Neruda. Pablo Neruda Era el seudónimo y, más tarde, el nombre legal del poeta, diplomático y político chileno Ricardo Eliécer Neftalí Reyes Basoalto (12 de julio de 1904 - 23 de septiembre de 1973). Derivó su seudónimo del poeta checo Jan Neruda. Pablo Neruda ganó el Premio Nobel de Literatura en 1971  “Algún día en cualquier parte, en cualquier lugar indefectiblemente te encontrarás a ti mismo, y ésa, sólo ésa, puede ser la más feliz o la más amarga de tus horas”.      

Thousands of people die each year from influenza. The CDC recommends that almost all people (with a few rare exceptions) receive the flu vaccine every year. But the disease and the vaccine are poorly understood. In this episode, we discuss the flu, its treatment and its prevention. Resources: Influenza vaccine effectiveness in preventing outpatient, inpatient, and severe cases of laboratory-confirmed influenza Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials.   Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk! Listen on iTunes Listen on Stitcher Now Available on Google Play Music!

Thousands of people die each year from influenza. The CDC recommends that almost all people (with a few rare exceptions) receive the flu vaccine every year. But the disease and the vaccine are poorly understood. In this episode, we discuss the flu, its treatment and its prevention. Resources: Influenza vaccine effectiveness in preventing outpatient, inpatient, and severe cases of laboratory-confirmed influenza Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials.   Be sure and subscribe in iTunes or Stitcher if you haven’t already.  And you know we’d appreciate it so much if you would tell your friends about 2 Docs Talk! Listen on iTunes Listen on Stitcher Now Available on Google Play Music!

Oseltamivir, or Tamiflu, stockpiling during the 2009 H1N1 epidemic highlighted significant problems with drugs trials policy

Pearls and take home messages from our weekly conference. This week, we review talks on influenza and pediatric foreign body aspiration. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_19_0_Final.m4a Download Leave a Comment Tags: Aspiration, Foreign Body, Influenza, Oseltamivir, Tamfiflu Show Notes Influenza Populations at High Risk for Severe Influenza – IDSA ALiEM: Neuraminidase Inhibitors for Influenza – The Truth, The Whole Truth, and Nothing But the Truth. Finally. EM Lit of Note:

Pearls and take home messages from our weekly conference. This week, we review talks on influenza and pediatric foreign body aspiration. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_19_0_Final.m4a Download Leave a Comment Tags: Aspiration, Foreign Body, Influenza, Oseltamivir, Tamfiflu Show Notes Influenza Populations at High Risk for Severe Influenza – IDSA ALiEM: Neuraminidase Inhibitors for Influenza – The Truth, The Whole Truth, and Nothing But the Truth. Finally. EM Lit of Note:

Pearls and take home messages from our weekly conference. This week, we review talks on influenza and pediatric foreign body aspiration. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_19_0_Final.m4a Download Leave a Comment Tags: Aspiration, Foreign Body, Influenza, Oseltamivir, Tamfiflu Show Notes Influenza Populations at High Risk for Severe Influenza – IDSA ALiEM: Neuraminidase Inhibitors for Influenza – The Truth, The Whole Truth, and Nothing But the Truth. Finally. EM Lit of Note: Remember,

Hosts: Vincent Racaniello, Alan Dove, Rich Condit, and Kathy Spindler The TWiV team reviews a meta-analysis of clinical trial reports on using Tamiflu for influenza, and suggestions on how to rescue US biomedical research from its systemic flaws. Links for this episode World Malaria Day Review of oseltamivir clinical trials (Brit Med J) Effectiveness of Tamiflu questioned (NHS choices) Tamiflu campaign (Brit Med J) Rescuing US biomedical research (PNAS) Letters read on TWiV 282 Weekly Science Picks Alan - Northampton AirportVincent - Particle FeverKathy - Turn iPhone into microscopeRich - My favorite science gifs Listener Pick of the Week Nathan - The Ascent of Man (YouTube) Send your virology questions and comments (email or mp3 file) to twiv@twiv.tv

As the flu season and the threat of avian flu comes closer, Professor John Oxford from the Royal London Hospital discusses what the flu is, where flu comes from and whether drugs and vaccines can prevent human and avian influenza. Professor Pat Troop, Chief Executive of the Health Protection Agency, describes the systems in place to stop an avian flu outbreak from spreading, and Dr Paul Digard, from the Division of Virology at the University of Cambridge, tells us how the flu virus escapes through layers of mucus in the nose. Meanwhile, in the Naked Scientists laboratory this week, Dave and... Like this podcast? Please help us by supporting the Naked Scientists

As the flu season and the threat of avian flu comes closer, Professor John Oxford from the Royal London Hospital discusses what the flu is, where flu comes from and whether drugs and vaccines can prevent human and avian influenza. Professor Pat Troop, Chief Executive of the Health Protection Agency, describes the systems in place to stop an avian flu outbreak from spreading, and Dr Paul Digard, from the Division of Virology at the University of Cambridge, tells us how the flu virus escapes through layers of mucus in the nose. Meanwhile, in the Naked Scientists laboratory this week, Dave and... Like this podcast? Please help us by supporting the Naked Scientists