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4 December 2009
The Department of Health has issued two updated clinical management guidelines for pandemic H1N1 2009 influenza for adults and children and for women who are pregnant.
Action
Health professionals who are involved in the management of patients with, or suspected to have, pandemic H1N1 2009 influenza (swine flu) should familiarise themselves with these two guidelines. These guidelines are only intended to be used during the H1N1 2009 influenza pandemic and will be updated regularly. Users are advised to refer to the latest web-based guidelines at all times, which will be posted on the Department of Health website.
What do the guidelines cover?
The guidelines cover clinical epidemiology and recommendations for assessment and management in both primary and secondary care, including the management of complications.
Both guidelines point out that most disease seen in children and adults, including women who are pregnant, with pandemic H1N1 2009 influenza is mild.
The guideline for adults and children recognises that differentiation from other viral and bacterial infections is difficult in children and may be more problematic this winter, especially in children under one year old. The guideline for pregnancy also recognises that differentiation from other viral and bacterial infections may be difficult in pregnant women, and there should always be a heightened awareness that some obstetric complications may mimic the presentation of the illness e.g. chorioamnionitis.
Both children and adults, including women who are pregnant, should be offered antiviral treatment if H1N1 is suspected before the results of confirmatory tests are available.
Oseltamivir▼ is the drug of choice for the majority of patients. However, zanamavir▼ is recommended as first choice in patients five years of age and older who have renal disease. Zanamivir is also the antiviral of choice for women who are pregnant who do not have severe disease unless they suffer with conditions such as asthma or chronic pulmonary disease, or may have difficulty with an inhaled preparation, when oseltamivir should be used.
The NPC has produced four patient decision aids that may be helpful in consultations with children and adults when prescribing of oseltamivir is being considered.
Antibiotics should be considered in selected cases: signs of bacterial or respiratory tract infection, failure to respond to antiviral therapy, underlying diagnoses, and severe H1N1 disease.
Further information on swine flu can be found on the Swine Flu Section of the Department of Health website.
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