Viral Respiratory Therapy - Drew

When should empiric influenza antiviral therapy be started despite a negativerrapid test?

When clinical suspicion is high during influenza season and the patient is within the treatment window; treatment should not wait for confirmatory testing.

Which influenza antiviral is preferred in pregnancy?

Oseltamivir.

Which influenza patients should be treated even if >48 hours from symptom onset?

Hospitalized patients, patients with severe/progressive disease, and high-risk patients.

A patient with influenza and asthma needs antiviral therapy. Which agent should generally be avoided?

Zanamivir because of the risk of bronchospasm.

What monitoring is recommended during oseltamivir therapy?

Symptom improvement, nausea/vomiting, and renal function.

What counseling point is important when prescribing baloxavir?

Avoid coadministration with polyvalent cations and monitor symptom improvement.

Which influenza antiviral is preferred for hospitalized patients?

Oseltamivir.

For influenza post-exposure prophylaxis, when should therapy ideally be started?

Within 48 hours of exposure.

What is the preferred outpatient antiviral for a high-risk adult with mild-to-moderate COVID-19 within 5 days of symptom onset?

Nirmatrelvir/ritonavir (Paxlovid), if no contraindications exist.

What mnemonic helps remember outpatient COVID antiviral treatment windows?

5-5-7: Paxlovid = 5 days, Molnupiravir = 5 days, Remdesivir = 7 days from symptom onset.

A patient receiving Paxlovid takes simvastatin. What is the recommended management?

Temporarily hold simvastatin because of a significant CYP3A-mediated drug interaction.

What monitoring is recommended during Paxlovid therapy?

Medication interactions, renal function, and symptom rebound.

What monitoring should be performed before starting remdesivir?

Assess liver function tests and prothrombin time.

Which outpatient COVID-19 antiviral should generally be avoided during pregnancy?

Molnupiravir.

A hospitalized COVID-19 patient requires supplemental oxygen. What anti-inflammatory therapy is commonly recommended?

Dexamethasone, with consideration of tocilizumab or baricitinib in progressive inflammatory disease.

What is COVID-19 rebound?

Recurrence of symptoms or a new positive test after initial recovery; usually mild and occurring several days after improvement.

What is the mainstay of RSV treatment in adults?

Prevention and supportive care; there is no routinely recommended antiviral therapy.

A pregnant patient is 34 weeks gestation during RSV season. What intervention can protect her infant?

Maternal RSV vaccination during 32-36 weeks gestation.

When is nirsevimab recommended for an infant?

When maternal RSV vaccination was not received, is unknown, or occurred <14 days before delivery.

How long does a single dose of nirsevimab generally protect an infant from RSV?

Approximately 5 months, covering a typical RSV season.