Tag: Tamiflu

Does My Child Need a Flu Test?

Your child has a fever, cough, runny nose, body aches and chills.

Should you rush them to your pediatrician for a flu test?

Diagnosing the Flu with a Flu Test

While you may want to seek medical attention, depending on your child’s age and how sick they are, believe it or not, you don’t need a flu test to get diagnosed with the flu.

“If your doctor needs to know for sure whether you have the flu, there are laboratory tests that can be done.”

CDC on Diagnosing Flu

A flu test is an option though.

Most people do not need a flu test.
Most people do not need a flu test.

Is it a good option?

A necessary option?

“Most people with flu symptoms are not tested because the test results usually do not change how you are treated.”

CDC on Diagnosing Flu

While a diagnosis of the flu can be made clinically, based on your symptoms, a flu test can be a good idea:

  • to help determine the cause of an outbreak (mostly if there aren’t already a lot of flu cases in your area)
  • if someone is at high risk for flu complications

In general though, most people do not need a flu test, especially during the active part of flu season.

What’s the problem with doing a flu test?

“In January 2017, the FDA reclassified antigen-based RIDT systems into class II. This reclassification was to help improve the overall quality of flu testing. The reclassification was prompted, in part, by recognition that the poor sensitivity of some of antigen-based RIDTs resulted in misdiagnosed cases, and, according to anecdotal reports, even death.”

FDA on CLIA-Waived Rapid Flu Test Facts

Mostly, they are neither as accurate nor as easy to interpret as most folks think, even the newer versions of these tests.

Have you ever heard someone say that they tested positive for both flu A and flu B?

When a flu tests is positive for both A and B flu strains, it invalidates the test. They may have had either flu A or flu B or neither, but they almost certainly didn’t have both.

The antigen-based rapid flu tests that most doctors and clinics use, which give results in 10 or 15 minutes, are also prone to both false positive (you don’t really have the flu, even though your test was positive), and more commonly, false negative (you actually do have the flu, even though your test was negative) results, depending if flu is active at the time.

Other flu tests are available, but are more expensive and take longer to get results, so aren’t used as often. These include “rapid” nucleic acid detection based tests that can be done in a doctor’s office, rapid nucleic acid detection based tests and rapid influenza diagnostic tests that are done in a central lab, PCR tests, and viral cultures.

So why do so many people rush to the doctor to get a flu test?

Many think that if they are positive, then they can take Tamiflu or another flu medicine and get better faster.

The problem with thinking like that is that few people actually need to take Tamiflu, as at best, it only helps you get better about a day quicker than if you didn’t take it. That’s why the recommendations for Tamiflu say to reserve it for children under two to five years of age and others who might be at high risk for flu complications.

Since most other people don’t need to take Tamiflu, they don’t necessarily need a flu test or a definitive diagnosis of the flu. Again, even if they did need Tamiflu, the diagnosis of the flu could be made clinically.

And even more importantly, a negative flu test doesn’t necessarily mean that you don’t really have the flu, especially if you have classic flu symptoms in the middle of flu season. Again, a negative flu test could be a false negative.

“RIDTs may be used to help with diagnostic and treatment decisions for patients in clinical settings, such as whether to prescribe antiviral medications. However, due to the limited sensitivities and predictive values of RIDTs , negative results of RIDTs do not exclude influenza virus infection in patients with signs and symptoms suggestive of influenza. Therefore, antiviral treatment should not be withheld from patients with suspected influenza, even if they test negative.”

CDC on Guidance for Clinicians on the Use of Rapid Influenza Diagnostic Tests

Have you ever had a negative flu test and the doctor still gave you Tamiflu? Then why did they do the test?

Diagnosing the Flu Without a Flu Test

If the results of flu testing aren’t going to change how you are treated, then you probably don’t need to have the flu test done in the first place.

Plus it saves you from having a swab stuck up your nose.

But kids should have flu tests, right?

Although rapid flu tests might be a little more accurate in kids than adults, it is not by much, so you are left with the same issues.

A positive test might reassure you that it really is the flu, but your child could still have the flu if their test is negative. A diagnosis and treatment decision can be made clinically, without a flu test, remembering that most older, healthy kids don’t need to be treated with Tamiflu.

We can’t skip flu season (although we sure can try if we get vaccinated and protected), but we can try and skip flu testing season.

More on Flu Tests

What to Know About Xofluza for the Flu

Most people don’t understand that we have limited options to treat folks with the flu.

They still think that Tamiflu is some kind of wonder drug.

It isn’t. At best, if you take it within 48 hours of the start of your flu symptoms, you might “shorten the duration of fever and illness symptoms, and may reduce the risk of complications from influenza.”

Other flu drugs aren’t that much better, which is why they are typically reserved for those who are considered at high risk for flu complications.

What to Know About Xofluza for the Flu

That’s why many of us welcomed news of a new flu drug – Xofluza (baloxavir marboxil).

“This is the first new antiviral flu treatment with a novel mechanism of action approved by the FDA in nearly 20 years. With thousands of people getting the flu every year, and many people becoming seriously ill, having safe and effective treatment alternatives is critical. This novel drug provides an important, additional treatment option.”

Scott Gottlieb, M.D., FDA Commissioner

Unfortunately, while it has a new mechanism to treat the flu, there are plenty of reasons to not get too excited about Xofluza, despite what the headlines might be telling you:

  • the clinical benefit seems similar to Tamiflu
  • the two studies that were used to get Xofluza approved only looked at folks with mild to moderate flu symptoms (those with severe flu symptoms were excluded) and only looked at folks without complex medical problems, so we don’t know if it reduces hospitalizations, flu complications, or deaths from flu
  • flu virus strains might be able to mutate and develop resistance to Xofluza, although it is not clear if these strains could then be passed to others
  • the single dose treatment is only approved for adults and kids who are at least 12 years old
  • at $120 to $150, it is more expensive than generic Tamiflu

Still, if it works just as well as Tamiflu, but really does have fewer side effects, then that is a good thing, especially if it isn’t overused.

“The significant reduction in influenza viral replication with baloxavir treatment suggests the potential for reducing influenza virus spread to close contacts and should be studied through randomized, controlled trials in households and during institutional influenza outbreaks such as in longterm care facilities.”

Timothy M. Uyeki, M.D., M.P.H., M.P.P. on A Step Forward in the Treatment of Influenza

Could Xofluza make you less contagious to others?

That would be a good way to control outbreaks.

Why isn’t it approved for younger kids? The pediatric studies haven’t been completed yet, but among the postmarketing studies that the FDA are requiring are in infants, children between the ages of 12 months to less than 12 years, and the final report of a pediatric study from Japan.

Other postmarketing studies of Xofluza will include hospitalized patients, the use of Xofluza as post-exposure prophylaxis to prevent influenza in household contacts of an index case, and to monitor resistance.

Are you excited about Xofluza?
Are you excited about Xofluza?

Should folks be excited about Xofluza? While it is certainly nice to have an alternative to Tamiflu, an alternative that worked a lot better would have really gotten most of us excited.

Right now we’ll settle for folks only using anti-viral flu medications, whether it is Tamiflu, Relenza, or Xofluza, when they are truly necessary – for high risk children and adults.

Remember, not everyone with the flu needs these medications.

And they are certainly not a substitute for a flu vaccine, unless you have a true medical contraindication to getting vaccinated.

More on Xofluza

Treating the Flu and Hard to Control Flu Symptoms

It is much easier to prevent the flu with a flu shot than to try and treat the flu after you get sick.
It is much easier to prevent the flu with a flu shot than to try and treat the flu after you get sick.

Unfortunately, like most upper respiratory tract infections, the flu is not easy to treat.

What are Flu Symptoms?

While a cold and the flu can have similar symptoms, those symptoms are generally more intense and come on more quickly when you have the flu.

These flu symptoms can include the sudden onset of:

  • fever and chills
  • dry cough
  • chest discomfort
  • runny nose or stuffy nose
  • sore throat
  • headache
  • body aches
  • feelings of fatigue

And more rarely, vomiting and diarrhea.

In contrast, cold symptoms come on more gradually and are more likely to include sneezing, stuffy nose, sore throat, and mild to moderate coughing. A cold is also less likely to include a headache, fatigue, chills, or aches. And while either might have fever, it will be more low grade with a cold.

As with other infections, flu symptoms can be very variable. While some people might have a high fever, chills, body aches, constant coughing, and can hardly get out of bed, others might have a low grade fever and much milder symptoms.

That variability also applies to how long the flu symptoms might last. Some people are sick for a good 7 to 10 days, while others start to feel better in just a few days.

Treating Flu Symptoms

Although there aren’t many good treatments for the flu, that variability in flu symptoms makes it hard to even know if any you try really work.

For kids older than 4 to 6 years and adults, you could treat symptoms as necessary, including the use of decongestants and cough suppressants.

And of course, almost everyone might benefit from pain and fever relievers, drinking extra fluids, and rest, etc.

Treating the Flu

In addition to symptomatic flu treatments, there are also antiviral drugs that can actually help treat your flu infection.

These flu medications include oseltamivir (Tamiflu), zanmivir (Relenza), and peramivir (Rapivab). Of these, oral Tamiflu is the most commonly used. It can also be used to prevent the flu if taken before or soon after you are exposed to someone with the flu.

“If liquid Tamiflu is not available and you have capsules that give the right dose (30 mg, 45 mg or 75 mg), you may pull open the Tamiflu capsules and mix the powder with a small amount of sweetened liquid such as regular or sugar-free chocolate syrup. You don’t have to use chocolate syrup but thick, sweet liquids work best at covering up the taste of the medicine.”

FDA – Tamiflu: Consumer Questions and Answers

Unfortunately, these flu drugs are not like antibiotics you might take for a bacterial infection. You don’t take Tamiflu and begin to feel better in day or two. Instead, if you take it within 48 hours of the start of your flu symptoms, you might “shorten the duration of fever and illness symptoms, and may reduce the risk of complications from influenza.”

At best, you are likely only going to shorten your flu symptoms by less than a day. And considering the possible side effects of these medications and their cost, they are often reserved for high risk patients, including:

  • children who are less than 2 years old
  • adults who are at least 65 years old or older
  • anyone with chronic medical problems, including asthma, diabetes, seizures, muscular dystrophy, morbid obesity, immune system problems, and those receiving long-term aspirin therapy, etc.
  • pregnant and postpartum women
  • anyone who is hospitalized with the flu
  • anyone with severe flu symptoms

That means that most older children and teens who are otherwise healthy, but have the flu, don’t typically need a prescription for Tamiflu. The current recommendations don’t rule out treating these kids though.

“Antiviral treatment also can be considered for any previously healthy, symptomatic outpatient not at high risk with confirmed or suspected influenza on the basis of clinical judgment, if treatment can be initiated within 48 hours of illness onset.”

Antiviral Agents for the Treatment and Chemoprophylaxis of Influenza – Recommendations of the Advisory Committee on Immunization Practices (ACIP)

There is a lot of controversy surrounding the use of Tamiflu and other anti-viral flu medications, with some studies and many experts thinking that they should rarely be used, if ever, stating that they are not as useful as others claim. Others state that while they not perfect, they are all we have, and there is enough evidence to recommend their use.

Treating Hard to Control Flu Symptoms

Instead of learning about treating hard to control flu symptoms, which might require medical attention, it is probably much more important to learn how to recognize these severe flu symptoms that might be hard to control.

Your child’s flu might be getting worse and require quick medical attention if you notice:

  • fast or hard breathing
  • complaints of chest pain
  • that it is hard to wake up your child
  • irritability to the point that your child is not consolable
  • signs of dehydration because your child won’t drink any fluids
  • that your child is complaining of being dizzy or is feeling lightheaded

You might also need to seek medical attention if your child with the flu was getting better, but then worsens again, with the return of a fever and more severe coughing, etc.

What to Know About Treating the Flu and Flu Symptoms

In addition to basic symptomatic care for your child’s flu symptoms, including the fever, cough, and runny nose, etc., Tamiflu can be an option to treat high risk kids with the flu.

And remember that it is recommended that everyone who is at least six months old should get a yearly flu vaccine.

More Information on Treating Hard to Control Flu Symptoms