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Early use of antivirals ‘significantly’ affects flu outcomes: Study

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The research, published in the International Journal of Infectious Diseases, was conducted at two major metropolitan training hospitals in Adelaide from 2016–20, and collected data from 1828 adult patients who were hospitalised with influenza.
 
Patients who received early treatment (less than 48 hours) with oseltamivir (sold as Tamiflu) experienced a reduced length of hospital stay and were less likely to be readmitted within 30 days – but there was no effect on 30-day mortality.
 
Lead researcher Dr Yogesh Sharma, senior consultant at Flinders Medical Centre and senior lecturer at Flinders University’s College of Medicine and Public Health, told newsGP these results might influence future management of patients with influenza.
 
‘What we have drawn from this data is, the earlier we can start oseltamivir in severe influenza, the better the outcomes will be,’ he said.
 
While Dr Sharma’s research focused on patients with influenza severe enough to require hospitalisation, he says the same principles should apply in general practice.
 
‘If somebody’s presenting within 48 hours of onset of symptoms, even if they’re previously well, we can give antivirals to shorten the duration of disease,’ he said.
 
Dr Sharma believes this should be the case for all patients, but says it is particularly important for those in a high-risk category, which he defines as people who are:
 

• aged more than 65
• pregnant
• immunocompromised
• taking high-dose steroids
• chronically on low-dose steroids
• transplant patients
• nursing home residents
• those with obesity.

 
‘Even if [people in the high-risk group] present a bit later, which is most often the case, a clinical judgement must be in place,’ he said.
 
‘GPs should consider starting treatment as early as possible if a patient is in a high-risk group, because the outcomes may be better.’
 
A further study of the same data, also co-authored by Dr Sharma, was recently published in the international journal IJC Heart & Vasculature.
 
That study found that both inpatient and 30-day mortality were ‘significantly’ higher among influenza patients with acute high-sensitive-troponins (hsTnT) when compared to those with negative troponins.
 
Consequently, Dr Sharma says if a patient experiences an acute change in troponin levels while in hospital for influenza, further cardiac follow up is required.
 
‘There needs to be vigilance in the post-discharge period,’ he said.
 
Moreover, it is imperative to look into whether these patients have any ‘hidden’ underlying coronary artery disease and that risk factors should be optimised.
 
While neither study focused on preventive care, Dr Sharma says one of the key messages he wants to convey about minimising the risk of poor outcomes from influenza is the importance of prevention through vaccination – an area GPs play a vital role in.
 
Dr Sharma is concerned this message may be overshadowed this year by talks of the upcoming vaccines against COVID-19.
 
He is also concerned there may be a false sense of security among patients about the likelihood of contracting influenza, based on the fact there were so few infections during last year’s influenza season.
 
In June last year, newsGP reported that measures aimed at reducing spread of COVID-19, such as physical distancing and good hand hygiene, had seen Australian flu cases drop by more than 99% compared to 2019.
 
‘In 2020 we didn’t have many flu patients,’ Dr Sharma said.
 
‘That’s probably because of the COVID restrictions – there wasn’t much community transmission – and international travel wasn’t there.
 
‘Once COVID restrictions are eased off and international travel starts [again], I think flu will come back again.’
 
Regardless, Dr Sharma says the message around vaccinating against influenza should not be diluted.
 
‘We should still encourage flu vaccination every year,’ he said.
 
‘There is evidence that if you give flu vaccination, especially in the high risk group, it reduces cardiovascular events.
 
‘It may also prevent patients from coming to hospital [in the first place] and there are mortality benefits, so we should encourage flu vaccination in all patients.’
 
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antivirals influenza oseltamivir vaccine

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