H1n1 (swine flu) for the clinician

Diagnosis, Testing and Treatment Recommendations for Flu-Like Illness
Children’s Healthcare of Atlanta: Aug. 26 2009

DIAGNOSIS AND TESTING:
The Rapid Flu Antigen Test is highly inaccurate, with high incidence of false negative AND false positive, and is not
recommended AT ALL. Children’s has ceased providing Rapid Testing in the EDs and Immediate Care Centers.
Decisions on diagnosis and treatment should be based on clinical grounds. The symptoms of flu include cough, sore
throat, myalgia and headache, but may not have a fever. In addition, patients may have GI symptoms like vomiting and
diarrhea.
INFECTION CONTROL:
Staff and physician personal protection equipment (PPE), and patient placement when evaluating patients with respiratory
symptoms. Use contact-droplet precautions (surgical mask and use a private room). If possible, there should be sick and
well waiting rooms and patients should be seen as quickly as possible. Strict hand hygiene before and after patient
contact should be maintained.
TREATMENT:
Treatment with Tamiflu should be reserved for high risk groups within the pediatric population (chronic lung disease,
diabetes mellitus, severe asthma, cystic fibrosis, renal disease, immunosuppressed patients, clinically significant heart
disease), or those with severe disease. The use of the drug is most beneficial if started early in the course of illness.
Normal host, flu-like symptoms, WELL appearing – Do not test or treat
Normal host, flu-like symptoms, ILL appearing – Treatment choice: Oseltamivir (Tamiflu), antibiotics, fluids,
workup and admission based on clinical findings, respiratory viral culture only if admitted Compromised host, flu-like symptoms – Respiratory viral culture, Oseltamivir, antibiotics, fluids, workup and
admission based on clinical findings. If discharging home, consider ID or Epidemiology consult on Respiratory
FA Panel
Antiviral Treatment for children <1 year using
Recommended treatment dose for 5 days
Oseltimivir (Tamiflu)
Antiviral Chemoprophylaxis of children <1 year
Recommended prophylaxis dose for 10 days
using Oseltimivir (Tamiflu)

Not recommended unless situation judged critical due to limited data on this age group
OPTIMAL TREATMENT REGIMENS:
 Seasonal Influenza A(H1N1) – Rimantadine or Amantadine*  Influenza B- Oseltamivir (Zanamivir* is an option in age > 7 years)  H1N1 (Swine Flu) - Oseltamivir (Zanamivir* is an option in age > 7 years) *These medications are in extreme short supply and are contraindicated in patients with asthma or other chronic lung
diseases

PROPHYLAXIS OF FAMILY MEMBERS:
Physician discretion and depends on certainty of diagnosis and high risk individuals in the family. Provide prescription
and refer to Georgia Division of Public Health Hotline @ 1-888-899-9788.
OUTPATIENT DISCHARGE INSTRUCTIONS:
Patient may return to school/daycare 24 hours after resolution of fever without antipyretic. For additional information and
guidance, please consult the CDC and AAP websites.
Children’s influenza information is based on best practices aggregated from several leading infection prevention, pediatric healthcare and infectious
disease organizations including the Centers for Disease Control and Prevention, the American Academy of Pediatrics, the Healthcare Infection
Control Practices Advisory Committee (HICPAC) and Society for Healthcare Epidemiologists (SHEA).


2009 Children’s Healthcare of Atlanta, Inc. All rights reserved. 

Source: http://choa.org/Menus/Documents/Flu/FluDiagnosis_Testing.pdf