Treatments for influenza include a range of medications and therapies that are used in response to disease influenza. Treatments may either directly target the influenza virus itself; or instead they may just offer relief to symptoms of the disease, while the body's own immune system works to recover from infection. The main classes of antiviral drugs used against influenza are neuraminidase inhibitors, such as zanamivir and oseltamivir, polymerase acidic endonuclease inhibitors such as baloxavir marboxil, or inhibitors of the viral M2 protein, such as amantadine and rimantadine. These drugs can reduce the severity of symptoms if taken soon after infection and can also be taken to decrease the risk of infection. However, virus strains have emerged that show drug resistance to some classes of drug.
Symptomatic treatment The United States authority on disease prevention, the Centers for Disease Control and Prevention (CDC), recommends that people with influenza infections:
Stay at home Get plenty of rest Drink a lot of liquids Do not smoke or drink alcohol Consider over-the-counter medications to relieve flu symptoms Consult a physician early on for best possible treatment Warning signs are symptoms that indicate that the disease is becoming serious and needs immediate medical attention. These include:
Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Dizziness Confusion Severe or persistent vomiting In children other warning signs include irritability, failing to wake up and interact, rapid breathing, and a blueish skin color. Another warning sign in children is if the flu symptoms appear to resolve, but then reappear with fever and a bad cough.
Antiviral drugs Antiviral drugs directly target the viruses responsible for influenza infections. Generally, anti-viral drugs work optimally when taken within a few days of the onset of symptoms. Certain drugs are used prophylactically, that is they are used in uninfected individuals to guard against infection. Four licensed influenza antiviral agents are available in the United States: zanamivir, oseltamivir phosphate, peramivir, and baloxavir marboxil. They are available through prescription only.
In Russia and China a drug called arbidol is also used as a treatment. Testing of the drug has predominantly occurred in these countries and, although no clinical trials have been published demonstrating this is an effective drug, some data suggest that this could be a useful treatment for influenza.
Interferons Interferons are cellular signalling factors produced in response to viral infection. Research into the use of interferons to combat influenza began in the 1960s in the Soviet Union, culminating in a trial of 14,000 subjects at the height of the Hong Kong Flu of 1969, in which those treated prophylactically with interferon were more than 50% less likely to suffer symptoms, though evidence of latent infection was present. In these early studies leukocytes were collected from donated blood and exposed to a high dose of Newcastle disease, causing them to release interferons. Although interferon therapies became widespread in the Soviet Union, the method was doubted in the United States after high doses of interferon proved ineffective in trials. Though the 1969 study used 256 units of interferon, subsequent studies used up to 8.4 million units. It has since been proposed that activity of interferon is highest at low concentrations. Phase III trials in Australia are planned for 2010, and initial trials are planned in the U.S. for late 2009. Interferons have also been investigated as adjuvants to enhance to effectiveness of influenza vaccines. This work was based on experiments in mice that suggested that type I interferons could enhance the effectiveness of influenza vaccines in mice. However, a clinical trial in 2008 found that oral dosing of elderly patients with interferon-alpha actually reduced their immune response to an influenza vaccine. Viferon is a suppository of (non-pegylated) interferon alpha-2b, ascorbic acid (vitamin C), and tocopherol (vitamin E) which was reported in two small studies to be as effective as arbidol. Another interferon alfa-2b medicine, "Grippferon", nasal drops, is used for treatment and emergency prevention of Influenza and cold. Its manufacturers have appealed to the WHO to consider its use against avian influenza and H1N1 Influenza 09 (Human Swine Flu), stating that it was used successfully in Russia for eight years, but that "the medical profession in Europe and the USA is not informed about this medicine".
Corticosteroids Corticosteroids can be prescribed for severe influenza; however, the currently available evidence is insufficient to determine their effectiveness, and more high-quality research, including randomized controlled trials, is needed to clarify their role in influenza treatment. A systematic review assessed the effectiveness and risks of corticosteroids as an adjunctive treatment for influenza, given their common use for severe cases due to their anti-inflammatory and immunomodulatory properties. The review included 30 studies with a total of 99,224 participants, primarily observational studies, and one randomized controlled trial. A meta-analysis of 21 studies (9,536 participants) suggested an association between corticosteroid use and increased mortality. A stratified analysis of adjusted studies also indicated higher mortality risk, and corticosteroid therapy was linked to an increased likelihood of hospital-acquired infections. The certainty of the evidence was very low due to potential confounding by indication and inconsistencies in study designs and reporting.
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