Pregnant women with suspected or confirmed influenza should get early treatment with either oseltamivir or zanamivir, the Centers for Disease Control and Prevention said in updated recommendations.
Treatment should start “as early as possible,” and “should not wait for laboratory confirmation of influenza,” said the detailed recommendations (www.cdc.gov/h1n1flu/pregnancy/antiviral_messages.htm
The CDC recommendations explained that pregnant women are at higher risk for severe complications and death from influenza, including both pandemic influenza A(H1N1) and seasonal flu. “The available risk-benefit data indicate pregnant women with suspected or confirmed influenza should receive prompt antiviral therapy. Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use.” The agency said treatment should start within 48 hours of illness onset, and that laboratory confirmation isn't needed because a negative result from a rapid test doesn't rule out influenza.
“Since rapid access to antiviral medications is essential, health care providers who care for pregnant women should develop methods to ensure that treatment can be started quickly after symptom onset,” the recommendations said. This means telling pregnant women about the signs and symptoms of flu and alerting them to the need for early treatment. It also requires physicians to ensure that their pregnant patients have rapid access to telephone consultation and clinical evaluation. The CDC advised physicians to “consider empiric treatment of pregnant women based on telephone contact” when hospitalization isn't needed to cut delays before starting treatment.
The recommendations also called for considering an antiviral regimen for postexposure prophylaxis in pregnant women following contact with someone likely infectious with influenza. The drug of choice for prophylaxis may be zanamivir because of its limited systemic absorption. The suggested regimen was two 5-mg inhalations (10 mg total) once daily for 10 days. But zanamivir can produce respiratory complications. For women at risk for respiratory problems, oseltamivir is a reasonable alternative, given as 75 mg once daily for 10 days. As of mid-September, most pandemic H1N1 influenza viruses are susceptible to both drugs, the CDC said. Treatment after signs and symptoms of influenza appear was advised as an alternative to chemoprophylaxis.
Although people infected with influenza do not always have fever, a recent series of pregnant women infected by pandemic H1N1 influenza showed fever in 97% (the next most common symptoms were cough, in 94%, and rhinorrhea, in 59%). Fever in pregnant women needs treatment because it appears to pose a risk to the fetus. Acetaminophen appears to be the best option for treatment of fever.