Early treatment is especially important for patients who are at increased risk of developing complications, those who present with severe illness or those with worsening signs and symptoms. The experience of clinicians, including those who have treated severe cases of pandemic influenza, and national authorities suggests that prompt administration of these drugs following symptom onset reduces the risk of complications and can also improve clinical outcome in patients with severe disease. This experience further underscores the need to protect the effectiveness of these drugs by minimizing the occurrence and impact of drug resistance. WHO encourages clinicians to be alert to two situations that carry a high risk for the emergence of viruses resistant to oseltamivir. The risk of resistance is considered higher in patients with severely compromised or suppressed immune systems who have prolonged illness, have received oseltamivir treatment especially for an extended duration, but still have evidence of persistent viral replication. In both of these clinical situations, health care staff should respond with a high level of suspicion that oseltamivir resistance has developed. Laboratory investigation should be undertaken to determine whether resistant virus is present and appropriate infection control measures should be implemented or re-enforced to prevent spread of the resistant virus. When a drug-resistant virus is detected, WHO further recommends that an epidemiological investigation be undertaken to determine whether onward transmission of the resistant virus has occurred.
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Although vaccination is the preferred option for preventing influenza, antivirals can be useful when the vaccine fails, for example, due to. At least one EU country the UK makes specific recommendations on when to use antivirals according to the levels of circulating influenza viruses as determined by surveillance. To date there have been few instances of resistance to the neuraminidase inhibitors and resistant viruses that transmit on are very rare. Resistant mutants to the M2 inhibitors have been detected in a number of countries and all current circulating influenza viruses are resistant to M2 inhibitors. Therefore, the use of M2 inhibitors in treatment of influenza is not recommended. The policy and practice on the use of antivirals varies between European countries. In some countries, using evidence-based policies, antivirals are only recommended for adults who are at increased risk of the complications of flu. They are generally not recommended for otherwise healthy adults with ordinary influenza.
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