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NEW: 2024-2025 Flu Testing and Treatment

Date: 09/24/24

According to the Centers for Disease Control and Prevention (CDC), the flu causes millions of illnesses, hundreds of thousands of hospitalizations and tens of thousands of deaths each year in the U.S. The best way to protect against the flu is with an annual flu vaccine.

Superior HealthPlan Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP members three years of age and older have the option to obtain their vaccine at a participating pharmacy in addition to their medical provider. The vaccination is also available to Wellcare By Allwell (HMO and HMO DSNP), Ambetter from Superior HealthPlan and Superior STAR+PLUS Medicare-Medicaid Plan (MMP) members, if provided by a participating pharmacy and/or medical provider licensed to administer the vaccine. The flu vaccine can be given at the same time as the COVID-19 vaccine. If you haven’t already, please encourage your patients to get their flu immunization in a timely manner.

The flu is generally acutely debilitating, but self-limiting in the general population. When a patient shows signs of the flu, providers must determine if testing and treatment with antivirals is necessary.

The CDC has issued the 2024-2025 recommendations and guidelines for the diagnosis of seasonal flu. To obtain more information, please visit the CDC 2024-2025 Flu Season webpage.

Recommended Dosage and Duration of Treatment or Prophylaxis for Influenza

One of the most popular antiviral therapies for influenza is Tamiflu®. According to the Food and Drug Administration (FDA), Tamiflu® should only be considered in the first two days of symptoms. This is when the medication will be most effective because viral shedding peaks at 24 to 48 hours of illness, and then rapidly declines. Please note:

  • Oseltamivir is the generic for Tamiflu®.
  • Tamiflu® is indicated for the treatment of uncomplicated acute illness due to influenza infection in patients 2 weeks of age and older who have been symptomatic for no more than 2 days. It is also indicated for prophylaxis of influenza A and B in patients 1 year and older.
  • Dosing and Administration:
    • Treatment of Influenza
      • Adults and adolescents (13 years and older): 75 mg twice daily for 5 days.
      • Pediatric patients 1 to 12 years of age: Based on weight twice daily for 5 days.
      • Pediatric patients 2 weeks to less than 1 year of age: 3mg/kg twice daily for 5 days.
      • Renally impaired adult patients (creatinine clearance >30-60 mL/min): Reduce to 30 mg twice daily for 5 days.
      • Renally impaired adult patients (creatinine clearance >10-30 mL/min): Reduce to 30 mg once daily for 5 days.
      • ESRD patients on hemodialysis: Reduce to 30 mg immediately and then 30 mg after every hemodialysis cycle. Treatment duration not to exceed 5 days.
      • ESRD patients on CAPD: Reduce to a single 30 mg dose immediately.
    • Prophylaxis of Influenza
      • Adults and adolescents (13 years & older): 75 mg once daily for at least 10 days.
        • Community outbreak: 75 mg once daily for up to 6 weeks
      • Pediatric patients 1 to 12 years of age: Based on weight once daily for 10 days.
        • Community outbreak: Based on weight once daily for up to 6 weeks.
      • Renally impaired adult patients (creatinine clearance >30-60 mL/min): Reduce to 30 mg once daily.
      • Renally impaired adult patients (creatinine clearance >10-30 mL/min): Reduce to 30 mg once every other day.
      • ESRD patients on hemodialysis: Reduce to 30 mg immediately and then 30 mg after alternate hemodialysis cycles for the recommended duration of prophylaxis.
      • ESRD patients on CAPD: Reduce to 30 mg immediately and then 30 mg.
  • Preferred for treatment of pregnant women.
  • Tamiflu® does not cure the flu. It may only help shorten the duration of the flu if used properly.
  • Efficacy of Tamiflu® has not been established for patients who begin treatment after 48 hours of symptoms. This is due to the above noted viral shedding window having already occurred, likely limiting the efficacy of the product.
  • Tamiflu® is not a substitute for early influenza vaccination on an annual basis, as recommended by the CDC Advisory Committee on Immunization Practices (ACIP).
  • Emergence of resistant mutations could decrease drug effectiveness. Consider the available information on influenza drug susceptibility patterns and treatment effects when determining treatment in your region.
  • Prophylaxis with antiviral medication is not generally recommended by the CDC, but may be considered in certain people, when exposed to another individual with influenza if the person is at very high risk for influenza complications or has severe immune deficiency and therapy is initiated within 48 hours of exposure.

Another option for treating influenza is Xofluza®. The FDA suggests considering Xofluza® in the first two days of symptoms when the medication will be most effective, because viral shedding peaks at 24 to 48 hours of illness and then rapidly declines. This medication is similar to Tamiflu® but is a single dose regimen rather than a multi-day treatment. Additionally, this drug is only indicated for the treatment of influenza and not prophylaxis. Please note:

  • Xofluza® is indicated for the treatment of uncomplicated acute illness due to influenza infection in patients 5 years of age and older who have been symptomatic for no more than 48 hours.
  • Xofluza® does not cure the flu. It only helps to possibly shorten the duration of the flu if used properly.
  • Dosage and administration:
    • Patients weighing less than 20 kg should receive a single dose at 2 mg/kg.
    • Patients weighing between 20 kg and 80 kg should receive a single dose of 40 mg.
    • Patients weighing 80 kg or more should receive a single dose of 80 mg.
    • Safety and efficacy of Xofluza® in patients 5 years of age or younger have not been established.

A third option for treating influenza is Relenza®. The FDA suggests Relenza® in the first two days of symptoms when the medication will be most effective, because viral shedding peaks at 24 to 48 hours of illness and then rapidly declines. This medication is an oral inhalation and is not indicated with individuals with underlying airway disease. Please note:

  • Relenza® is not a substitute for an annual influenza vaccine.
  • Relenza® is indicated for the treatment of uncomplicated acute illness due to influenza in patients seven years and older who have been symptomatic for no more than two days.
  • Prophylaxis with antiviral medication is not generally recommended by the CDC, but may be considered in certain people, when exposed to another individual with influenza if the person is at very high risk for influenza complications or has severe immune deficiency and therapy is initiated within 48 hours of exposure.
  • Dosage and administration: 
    • Treatment of influenza: 10 mg twice daily for five days.
  • Insufficient data for inhaled Relenza® in those with severe influenza disease.

More Information

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