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Why don’t doctors always give antiviral drugs for influenza?

Q. My daughter was recently diagnosed with the flu. Our pediatrician told us to give her ibuprofen and keep her hydrated. I know other children have been given medicine to treat their flu. Should my daughter have been prescribed an “anti-flu” medication?

A. As we reach the peak of flu season, the topic of flu treatment is a hot one – particularly when health care professionals may differ in how liberally they prescribe antiviral medications.

There are three recommended influenza antiviral medications this season: oral oseltamivir (Tamiflu), inhaled zanamivir (Relenza) and intravenous peramivir (Rapivab). Studies show that if an antiviral medication is started within 48 hours of the onset of flu symptoms, the length of the illness is shortened by one day. In the highest-risk patients, the medication may reduce the likelihood of hospitalization or pneumonia.

Why do physicians not prescribe this medication for every patient with the flu? There are several reasons. First and foremost, antiviral medications have their own list of possible side effects: nausea, vomiting, diarrhea, dizziness and behavioral changes (such as delirium and hallucinations). For healthy children and adults with a mild case of the flu, the risks of the medication may outweigh the benefits.

The other reasons are broader in scope. Widespread use of antivirals leads to shortages, making it unavailable to the sickest. Overuse and incorrect use of antiviral medications can lead to resistance, causing the medication to become ineffective over time. This has already occurred with older antiviral medications that are no longer used for influenza treatment.

For these reasons, antiviral medication is reserved for the highest-risk patients:

• Children younger than 2.

• Adults 65 years and older.

• People with certain chronic diseases such as asthma and diabetes.

• Individuals who are immuno-suppressed, morbidly obese or living in nursing homes.

• Women who are pregnant or within two weeks post-partum.

• Children and adolescents who are on long-term aspirin therapy.

• American Indians and natives of Alaska.

The medication is most effective if it is started within the first 48 hours of the disease. More information at