Experts: Overuse of flu drugs could cut effectiveness
Experts: Most “worried well” who were exposed to flu but not sick should not get antiviral drugs

By Bob LaMendola South Florida Sun Sentinel

출처 : South Florida Sun-Sentinel 5:01 p.m. EDT, September 15, 2009
http://www.sun-sentinel.com/business/sfl-swine-flu-preparation-091609,0,5300569.story

Doctors and hospitals should prepare not only for a surge of swine flu patients but also the “worried well,” relatives and friends who may accompany them asking for treatment because they were exposed to the virus, a panel of South Florida experts said Tuesday.

Only high-risk people such as the chronically ill should be given antiviral drugs solely to prevent an infection after they were exposed to a sick person, and medical professionals will have to be strong in saying no to the rest of the “worried well,” panel members said during a swine flu seminar at Broward General Medical Center in Fort Lauderdale.

“You will have a lot of panicky, demanding family members in your office. How do you deal with that? It’s up to your intestinal fortitude,” said Dr. Stephen Renae, an infectious disease specialist.

Antiviral drugs like Tamiflu and Relenza can shorten the duration of swine flu and can prevent it from causing illness in those who are exposed to the H1N1 flu virus, if taken within about 48 hours of the start of symptoms.

But the flu has been fairly mild so far, and the Centers for Disease Control and Prevention does not recommend giving drugs as a preventive measure except in those for whom the flu is a big risk, including pregnant women, children, adolescents and people with chronic illnesses such as lung disease, heart diseases and the like.

Also, a few cases of Tamiflu-resistant swine flu have appeared, making flu experts worry that overuse of antiviral drugs may reduce their effectiveness in stopping the flu in sick people. It’s also impotant to be sure sufficient supplies of antiviral drugs are available to those who need them, experts say. Doctors facing healthy, low-risk people who want drugs as a preventive should try to explain the situation, the panel said.

“Doctors need to use their best judgment and follow the CDC rules,” said Dr. Paula Thaqi, director of the Broward County Health Department. The same will be true, she said, when the first batches of H1N1 vaccine comes out in a few weeks and will be reserved for high-risk groups.

Dawn Nesbitt, chief emergency room nurse at Plantation General Hospital, who attended the seminar, said entire families have come to the ER asking about Tamiflu when a child in the household gets sick.

Eight to 10 sick students per day have been coming to her ER, sent there by schools when family members cannot get free to pick them up and bring them home, Nesbitt said.

The Palm Beach County Health Department has been trying to head off big crowds of people flooding physician offices and ERs by urging people to take care of themselves at home unless their symptoms are worrisome.

“You don’t necessarily have to run to the doctor’s office. Do that good old self-care, just like folks have done with influenza in the past,” said Al Grasso, coordinator for emergency preparation at the department.

Overall, Thaqi said she is pleased with the level of flu planning by doctors, hospitals and emergency rescue staffers in the community. Grasso said the same.

The new H1N1 virus is a worry for health experts because of its potential, not because it’s a major danger now. When it first came out in April, doctors feared it would be highly virulent and kill thousands. So far, it hasn’t. The nation has seen about 600 deaths, Florida 78. Experts still worry that the virus could mutate and become more serious, but so far that hasn’t happened.

“We’re hoping that will be a busy flu season and that’s all,” said Dr. Nabil El Sanadi, emergency medicine chief at the tax-assisted Broward Health system.

Bob LaMendola can be reached at blamendola@SunSentinel.com or 954-356-4526 or 561-243-6600, ext. 4526