Respiratory illness caused by bacteria can occur throughout the year; however, illness caused by S. Clinical Considerations The presence of certain signs or symptoms may help to distinguish the various causes of influenza-like illness. Nasal congestion and rhinorrhea are features of most cases of influenza-like illnesses, but are infrequent in patients with inhalational anthrax. Results of initial chest radiographs of 10 patients with inhalational anthrax indicated that 7 had mediastinal widening, 7 had infiltrates, and 8 had pleural effusion at the time of initial presentation; eventually pleural effusions were present in all of these patients.
Although most cases of influenza-like illness are not associated with radiographic findings of pneumonia , this can occur among the very young and in geriatric patients and patients with chronic lung disease. Influenza-associated pneumonia might be caused by the primary virus infection or, more commonly, by bacterial infection occurring coincident with or following influenza illness. Diagnostic Tests Several commercially available assays can be used for the rapid detection of influenza-like illnesses. Rapid tests for identification of influenza virus and RSV are available and, if used, should be done within the first 3-4 days of the illness when viral shedding is most likely.
Several available influenza rapid detection assays e. However, the clinical usefulness of these tests for the diagnosis of influenza in individual patients is limited because the sensitivity of the tests is relatively low. These rapid influenza tests should not be done on every individual presenting with influenza-like illness, but if used with viral cultures can help determine whether influenza viruses are circulating among specific populations e. The use of viral culture, in addition to rapid diagnostic tests, remains important because only cultures can provide information on the circulating influenza subtypes and strains.
Although there are no rapid screening tests to aid in diagnosis of inhalational anthrax in the early stages, blood cultures performed prior to initiation of anti-infective therapy can diagnostic. However, blood cultures should not be obtained routinely in patients with influenza-like illness who have no probable exposure to anthrax, but should be obtained in individuals in situations in which bacteremia is suspected. Clinical studies indicate that amantadine is as effective as rimantadine or influenza vaccination in preventing influenza A illness. The protective effect of amantadine or rimantadine and influenza vaccination may be additive.
In contrast to results of studies evaluating efficacy when antiviral prophylaxis is given for a season or part of a season, results of studies evaluating antiviral prophylaxis with amantadine or rimantadine after a known exposure have not been consistent. While postexposure prophylaxis with amantadine or rimantadine provided protection in families when the index case did not receive antiviral therapy, the drugs did not provide protection from influenza A infection in household contacts when amantadine or rimantadine was used to treat the index case, presumably because of spread of resistant virus within the household. However, prophylaxis with an antiviral agent e. While amantadine and rimantadine are only effective in preventing influenza A infections, oseltamivir and zanamivir can be effective in preventing both influenza A and influenza B infections.
Data are not available to date regarding the efficacy of any of these antiviral agents in preventing influenza in individuals who are severely immunocompromised. Short-term prophylaxis with an antiviral agent amantadine, oseltamivir, rimantadine, or zanamivir may be indicated for high-risk individuals, household contacts of high-risk individuals, and health-care personnel who receive influenza virus vaccine after influenza activity begins. Antiviral prophylaxis during peak influenza activity may be considered for unvaccinated individuals who have frequent contact with high-risk individuals, including employees of hospitals, clinics, and chronic-care facilities, household members, visiting nurses, and volunteers.
Antiviral prophylaxis also may be indicated when antigens contained in the current influenza virus vaccine do not closely match the viral strain, or when a poor antibody response to the vaccine is expected e. Antiviral prophylaxis throughout the influenza season or during peak influenza activity may be considered for high-risk individuals when influenza virus vaccine is contraindicated e. The ACIP states that, unless contraindicated, antiviral prophylaxis can be offered to any individual who wishes to avoid influenza illness and that the decision whether or not to use such prophylaxis should be made on an individual basis.
Individuals considered at high risk for lower respiratory tract complications and death following influenza infection include those 65 years of age or older; residents of nursing homes and other chronic-care facilities that house individuals of any age with chronic medical conditions; children and adolescents 6 months to 18 years of age receiving long-term salicylate therapy who may be at risk of developing Reye's syndrome after influenza infection; adults and children with chronic disorders of the cardiovascular or pulmonary systems including asthma ; and adults and children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases including diabetes mellitus , renal dysfunction, hemoglobinopathies, or immunosuppression including immunosuppression caused by drugs or HIV infection.
Although women who will be in the second or third trimester of pregnancy during the influenza season also are considered at high risk for influenza complications, safety of amantadine, oseltamivir, rimantadine, or zanamivir during pregnancy has not been established. Individuals at high risk, if they become ill with influenza, are more likely than the general population to require hospitalization, and hospitalization rates for these individuals may increase substantially during major influenza epidemics. Previously healthy children and younger adults also may require hospitalization for influenza-related complications, but the relative increase in their hospitalization rates during epidemics is lower than for individuals in the high-risk group.
Adjunctive Prophylaxis with Influenza Virus Vaccine Individuals at high risk for influenza complications still can be vaccinated with influenza virus vaccine after an outbreak of influenza has begun in a community. However, the development of antibodies in adults can take as long as 2 weeks after vaccination. Therefore, if influenza virus vaccine is administered after a local outbreak of influenza has begun, short-term antiviral prophylaxis should be considered for high-risk individuals. To provide protection until antibody responses to the vaccine develop, the antiviral agent usually is given for 2 weeks after vaccination.
However, children younger than 9 years of age in this situation who are receiving influenza virus vaccine for the first time may require antiviral prophylaxis for up to 6 weeks following vaccination or until 2 weeks after the second dose of the vaccine. Antiviral agents are used in the prevention and control of influenza outbreaks in hospitals or other institutions. When institutional outbreaks occur, antiviral prophylaxis should be administered to all residents, regardless of their vaccination status. If an outbreak is caused by a variant strain of virus that may not be controlled by the vaccine, the ACIP recommends that antiviral prophylaxis be considered for all employees, regardless of their vaccination status.
Antiviral prophylaxis may be indicated as an adjunct to influenza virus vaccine in individuals at high risk who are expected to have an inadequate antibody response to influenza virus vaccine, including HIV-infected individuals. Influenza virus is not traditionally classified as an opportunistic pathogen, but many experts consider vaccination against the virus as logical in any HIV-infected individual whether symptomatic or asymptomatic because of the possible risks of respiratory infections in such patients and protective antibody levels are likely in many such vaccinees.
Hematopoietic Stem Cell Transplant Recipients Individuals who undergo hematopoietic stem cell transplant HSCT are at risk for a variety of opportunistic infections, including community-acquired respiratory viral infections e. These guidelines recommend lifelong annual vaccination with influenza virus vaccine in all HSCT recipients who are 6 months of age or older. However, because the vaccine is not likely to be beneficial and is not recommended during the first 6 months after HSCT, antiviral prophylaxis can be used if community or nosocomial influenza outbreaks occur during this time period.
If influenza outbreaks occur and it has been 6-24 months after HSCT or it has been longer than 24 months after HSCT and the patient is still substantially immunocompromised i. In addition, during influenza A outbreaks, the HSCT recipient can receive antiviral chemoprophylaxis to provide protection until antibody responses to the vaccine develop. To help prevent transmission of influenza A to a susceptible HSCT recipient, if influenza outbreaks occur and health-care workers, family members, or other close contacts of the HSCT recipient receive influenza virus vaccine, they also should receive a regimen of antiviral chemoprophylaxis to provide protection until a response to the vaccine is obtained.
If a nosocomial outbreak occurs with an influenza A strain that is not contained in the available influenza virus vaccine, all healthy family members, close and household contacts, and health-care workers of HSCT recipients and candidates should receive antiviral prophylaxis until the end of the outbreak. Although experience is limited to date regarding use of neuraminidase-inhibitor antivirals oseltamivir, zanamivir in HSCT recipients, these drugs can be offered to health-care workers, family members, or other close contacts for prophylaxis if amantadine or rimantadine cannot be tolerated, if the outbreak strain of influenza A is resistant to amantadine or rimantadine, or if the outbreak strain is influenza B.
Recommendations for prevention of influenza virus infection in HSCT recipients are the same for both allogeneic and autologous transplants. The guidelines for preventing opportunistic infections among HSCT recipients published by the CDC, IDSA, and ASBMT should be consulted for additional information on preventing opportunistic infections in these patients including vaccinations and for information on hospital infection control, strategies for safe living after transplantation, and hematopoietic stem cell safety.
Influenza, Outbreak Control in Institutions and Settings with Close-Proximity Living Conditions Antiviral agents are used for the treatment and prophylaxis of influenza in hospitals and other institutions and are an important component of institutional outbreak control. Keep Amantadine out of the reach of children and away from pets. Do NOT use Amantadine if: Contact your doctor or health care provider right away if any of these apply to you. Some medical conditions may interact with Amantadine. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you: Some medicines may interact with Amantadine.
Tell your health care provider if you are taking any other medicines, especially any of the following: Thioridazine because tremors may be worsened in Parkinson patients Anticholinergics eg, scopolamine , hydrochlorothiazide, quinidine, quinine, stimulants eg, caffeine, methylphenidate, pseudoephedrine , or triamterene because they may increase the risk of Amantadine's side effects. This may not be a complete list of all interactions that may occur. Ask your health care provider if Amantadine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Important safety information: Amantadine may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Amantadine with caution. Do not drive or perform other possible unsafe tasks until you know how you react to it. Amantadine may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects. Limit alcohol intake while you are taking Amantadine.
Talk with you doctor before you drink alcohol or use medicines that may cause drowsiness eg, sleep aids, muscle relaxers while you are using Amantadine; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Do not become overheated in hot weather or while you are being active; heatstroke may occur. Amantadine only works against certain types of the flu; it does not treat other viral infections eg, the common cold. If you are taking Amantadine for the flu, be sure to use Amantadine for the full course of treatment. If you do not, the medicine may not clear up your infection completely.
The virus could also become less sensitive to this or other medicines. This could make the infection harder to treat in the future. You usually should not receive a live nasal flu vaccine within 14 days before or 2 days after you take Amantadine. The vaccine may not work as well. Talk with your doctor before you receive any vaccine. If you are taking Amantadine for Parkinson disease, increase physical activity slowly as your symptoms improve. Do not suddenly stop taking Amantadine without first checking with your doctor. Your dose may need to be lowered slowly to avoid side effects.
Attempts at preventing weight gain are Buy Acyclovir Legally amantadine hydrochloride capsules are also indicated in the treatment of uncomplicated respiratory tract illness caused by influenza A virus strains especially when administered early in the course of illness. In human medicine it is recommended to have caution when considering. Buy Amantadine no Prescription Because amantadine is primarily excreted unchanged in the urine, patients with renal impairment require dosage adjustments. Amitriptyline; Chlordiazepoxide: Moderate Additive anticholinergic effects and CNS effects may be seen when tricyclic antidepressants are used concomitantly with amantadine.
Beginning a weight-stabilizing medication after a low threshold of weight gain has occurred may have the safety and efficacy of extended-release amantadine e. Dose reduction or withdrawal from amantadine therapy can also cause neuroleptic malignant syndrome NMS. This often significant weight gain adversely affects health, increasing risks for developing cardiovascular disease, diabetes, sleep apnea, cancers of the colon, kidneys, uterus, endometrium and esophagus and osteoarthritis. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.
Mail Order Amantadine Online Pneumonias in man. And if you already have one or more credit cards you may still benefit from either buying Amantadine Online Without Prescription liquids. In 1985, a dea lab issued a classified report which stated that the federal reserve itself may be contaminating the currency through normal procedures. Do You Need a Prescription for Sumatriptan Online lindt-these swiss chocolates put confectionee world wide to the test, major credit cards open ih am-pm, su noon-pm. You may have a greater risk of side effects. If you need to stop this medicine amantadine capsules and tablets , you will want to slowly stop it as ordered by your doctor.
The chance of a type of skin cancer called melanoma may be raised in people with Parkinson's disease. It is not known if this medicine amantadine capsules and tablets may also raise the chance. Have skin exams while you take this medicine amantadine capsules and tablets. Talk with your doctor. How is this medicine Amantadine Capsules and Tablets best taken? Use this medicine amantadine capsules and tablets as ordered by your doctor. Read all information given to you. Follow all instructions closely. Take with or without food.
To gain the most benefit, do not miss doses. Keep taking this medicine amantadine capsules and tablets as you have been told by your doctor or other health care provider, even if you feel well. Talk with your doctor before getting a flu vaccine after taking this medicine amantadine capsules and tablets. Talk with your doctor before you take this medicine amantadine capsules and tablets if you have just gotten a flu vaccine. Talk with your doctor before you use other drugs and natural products that slow your actions. Do not switch between different forms of this medicine amantadine capsules and tablets without first talking with the doctor.
What do I do if I miss a dose? Take a missed dose as soon as you think about it. If it is close to the time for your next dose, skip the missed dose and go back to your normal time. Do not take 2 doses at the same time or extra doses. See also: Amantadine dosage information in more detail What are some side effects that I need to call my doctor about right away? Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
Change in how you act. Feeling confused. Very bad dizziness or passing out. Hallucinations seeing or hearing things that are not there.
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