Prescribing new antivirals for influenza

Vaccine resistance and influenza outbreaks

Imagine the joy of experiencing a late fall, winter, and spring season of never having to press the e-prescribing submit button in the electronic health record for an antiviral medication to treat an infant, child, or adolescent who is very ill after contracting influenza.

Such an experience may only be possible if all parents in the practice completely support vaccines, if every pregnant woman receives the influenza vaccine to protect the infant in the first 6 months, and if every infant older than age 6 months-plus each child and adolescent-receive the influenza vaccine prior to the start of the season.  Of course, all individuals interacting with the families would also need to be vaccinated-certainly not a novel idea as the influenza vaccination is an annual recommendation from the Center for Disease Control (CDC).

Unfortunately, there are a significant number of individuals who remain vaccine hesitant and vaccine resistant, so what action can a nurse practitioner (NP) take? Nurse practitioners and all healthcare providers must be knowledgeable about antiviral influenza medications and prescribe them per the current standard of practice.

New antiviral, Baloxavir: What NPs need to know

The Pharmacologist’s Notebook article in the February 2019 issue of Contemporary Pediatrics by Nadine Peart Akindele, MD, New therapeutic measure to combat influenza, presents the mechanism of action (MOA) for known antiviral influenza medications and for the most recent US Food and Drug Administration-approved medication baloxavir (Xofluza).

Dr. Akindele discusses the scientific evidence that has shown patterns of resistance by the influenza viruses to previously prescribed antiviral influenza medications, including oseltamivir (Tamiflu) and zanamivir (Relenza). She succinctly describes the MOA for baloxavir as well as oseltamivir and zanamivir [Flashback to benefits of Pharmacology classes!].

It is critically important for NPs to understand MOA and the link to disease pathophysiology in order to effectively prescribe the best medication plans for the presenting patient’s diagnosis. Dr. Akindele provides detailed information on the drug resistance that has emerged from oseltamivir and zanamivir, and how the MOA for baloxavir differs and will not be affected at this time by current resistant organisms.

Patient selection and indication

Baloxavir can only be prescribed for children aged 12 years and older who have had influenza symptoms for fewer than 48 hours. Furthermore, baloxavir can only be prescribed in children with uncomplicated infections because clinical trials have only been conducted within that specific population. For further details on prescribing dosages and recommendations for how to prescribe the baloxavir, including the synergism of oseltamivir and baloxavir, please read the article and, in particular, the prescribing recommendations described by Dr. Akindele.

Antivirals are an important part of treatment for pediatric/adolescent patients with diagnosed influenza, and we must be knowledgeable about which medications can be ordered for particular age groups.

SHOUT OUT to a fabulously intelligent adolescent!

This morning, as I was listening to an interview on the Today Show on the measles outbreak in several states across the United States, I heard an intelligent adolescent describe his scientific investigation concerning his decision making for taking the measles vaccine.¹ Ethan Lindenberger, an 18-year-old from Ohio, had not been vaccinated as his mother is a vaccine refuser. Ethan became concerned about the measles outbreak and searched for scientific evidence to make his decision about receiving the vaccine. During the interview, he eloquently articulated his research process and determined that the evidence reported by the CDC provided sound scientific evidence for him to receive the vaccine. I applaud his search for evidence, his understanding of scientific information, and his ability to make informed healthcare decisions. I hope he received the influenza vaccine as well. 

References:

1. The Hill. (2019). Teen defies parents, gets first vaccinations during measles outbreaks in US. [online] Available at: https://thehill.com/blogs/blog-briefing-room/news/429295-teen-defies-parents-gets-first-vaccination-shots-during-measles [Accessed Feb. 15 2019].