GETTYSBURG MEDICAL NEWS
THE CLINICAL VIEW
By: Philip E. Hoffsten, M.D.
27, January 2000

THE NEW FLU MEDICATIONS

There has been a recent splash of TV advertising directed to patients regarding medication for influenza. Both Relenza and Tamiflu have been touted as new medications to effectively treat influenza. I have noted news releases recently that doctors are prescribing these medications more than appropriately. The implication of the news articles was that other methods of dealing with influenza were being neglected with inappropriate reliance on the new medications Relenza and Tamiflu. I have had patients come to the clinic and tell me that they want the new flu medication and other patients come to the clinic and say they have influenza but they have heard terrible things about the new flu medications and do not want those. This seems an appropriate time to clarify the appropriate use of these medications.

To begin with, an influenza viral infection rarely presents as a “simple cold”. Influenza is a terrible systemic illness which most frequently begins with a sudden onset. Patients can often relate the hour that they first became ill with a high fever, headache, diffuse body aching and often associated with a cough, runny nose and respiratory difficulties. Untreated, an influenza viral infection will frequently run 7 to 14 days with several weeks required for complete recovery. An influenza viral infection is rarely fatal, although, associated with significant disability during the illness. Secondary bacterial infections are the most common cause of fatalities in individuals who develop the influenza syndrome and these require antibiotic therapy in order to recover. Contrary to popular believe, nausea, vomiting, abdominal pain and diarrhea are not common symptoms in people with an influenza viral infection, although, loss of appetite is frequently present.

It was known years ago that a drug called Amantadine (Symmetrel) could be used to reduce the severity of an influenza viral infection if the drug was started in the first day or two of the illness. If the use.of the drug was delayed to the third day or after, there was relatively little impact on the course of the influenza viral infection. Amantadine is available through your local pharmacist for about $10.00 for a complete course of treatment. It is effective against influenza A only and has minor side effects.

In 1993, a new medication called Flumadine was released to the market. It performed the same function as Amantadine and seemed to be as effective. It was a medication under patent at that time and, of course, the price is going to be higher. Flumadine is still available and at the local pharmacies at this time it costs around $32.00 for a course of treatment which is three times the cost of Amantadine.

Comes the fall and winter of 1999-2000 and two new medications come on the market. One of these is called Relenza. It involves the use of an inhaled powder used twice a day for five days. It must be used in the first two days of the influenza illness or it is not effective either. The price of a complete course of Relenza is around $47.00 about five times the cost of Amantadine.

Lastly came a product called Tamiflu. This is easier to use than the Relenza in that the Tamiflu is a simple tablet that is taken twice a day for five days. It, too, must be used in the first two days of the illness to be truly effective. Because Tamiflu is somewhat more convenient, the manufacture feels that it is a superior product to Relenza and charges $53.00 for a full course of treatment over five days time.

In objective studies, the manufactures of the new flu medications acknowledge that the average duration of symptoms of the influenza illness is decreased by 1.3 days on the average. In other words, instead of having the influenza viral illness miserable for ten days,you are only miserable for 8.7 days.

All four of these drugs function by decreasing the production of the virus that causes the influenza syndrome. Unfortunately, they cannot undo the damage already done by the virus already produced. Eventually, recovery from an influenza illness requires a response by the body’s own immune system to eliminate the virus and lead to full recovery.

So, if a person develops an acute high fever, aching all over with a cough, runny nose and the miseries, what is a body to do? If there is a suspicion that this represents a true influenza viral infection then your local healthcare provider can provide a quick test on nasal secretions and determine if the person really does have an influenza viral infection. If the influenza virus is confirmed as present and the illness is less than two days old, the use of one of the medications above may buy you 1.3 days less misery than you would have otherwise. To this time, there are no comparative studies to say one product mentioned above is superior to another. Thus, the use of Amantadine for $10.00 for treatment may very well work as well as Tamiflu costing $53.00 for treatment.

Very likely an acute illness with the influenza virus like picture is probably not due to influenza. There are many other viruses that cause this type of clinical illness and they are not effected at all by the medications mentioned above. Thus, the best treatment will come from mothers and wives who provide Tylenol, chicken soup, comfort, rest and time for the person to recover. For the mothers and wives who develop the viral influenza syndrome, best of luck. Try to get family and friends to provide the Tylenol, chicken soup and bedrest.

The viral influenza syndrome may occasionally be fatal in the very young, the very old and those with chronic debilitating illnesses such as emphysema, bronchitis or those on chemotherapy. When those individuals develop an acute febrile illness immediate and thorough evaluation by a healthcare provider is a necessary step for survival. The use of antibiotics to treat secondary bacterial infections may be a life saving necessity. When the individuals sputum production turns yellow, green or bloody the presence of a bacterial pneumonia can be assumed and immediate attention is important.

The healthcare providers at your local clinic or emergency room can help deal with the considerations outlined above and help select the best treatment for an individual. For any one liable to develop influenza like syndrome, the use of the flu vaccine each fall is an important step in prevention and avoiding the illness altogether. The use of flu vaccine is remarkably safe and does not cause the many symptoms that I often hear attributed to it.