Reply #97: A few more words

[McCamy Taylor]

Regarding medication:

All anti influenza medications work best if they are started ASAP after the onset of symptoms, within the first one to two days. Ideally, a person who knows that they have been exposed or those who can count upon being exposed (such as health care workers) should take an anti influenza medication to prevent infection. The drugs are even more effective as preventatives than they are at treating the symptoms of active disease.

Of the four anti virals which are now used to treat influenza, amantadine, rimantadine, oseltamivir and zanamivir, the first two are not effective against this new strain. So, do not think that your Symmetrel which you take for Parkinsons is going to protect you (the way that it ordinarily protects against influenza A). Also, do not take any left over Flumadine. Either the pill Tamiflu (the product Rummie made so much money on) or the spray Relenza should be effective. Regarding side effects, Relenza can not be used in those with asthma or other serious lung disease or in young children and because it is administered in a spray, doctors can not adjust the dosage to achieve a desired level in the blood stream as they can with some other anti flu medications (this last becomes a concern with sicker, hospitalized patients). Tamiflu can be used by everyone, however it caused some weird neurological and psychiatric side effects in a group of people in Japan a few years back including psychosis and suicide with the risk of self harm apparently higher in teenagers. (In recent years, the ability of a wide variety of medications to cause psychiatric side effects in teenagers has been recognized.) It can also cause gastrointestinal upset like nausea and diarrhea. This year a Tamiflu resistant strain of influenza (one which was covered by this year's flu vaccine) emerged, so if someone takes Tamiflu for presumed swine flu and gets no results, he or she could actually have the other, resistant human influenza. To sum up, Relenza is the only drug out there which (so far) treats every strain of influenza that is circulating, but it can not be used by everyone. Tamiflu will treat the more serious swine flu, but it might not treat ordinary human flu.

Since a major complication of influenza is pneumonia or other lower respiratory bacterial infections like bronchitis, people also need to be aware of the fact that resistant bacteria are increasingly causing these types of illnesses. While most pneumonia is caused by the bacteria called Strep Pneumomia or Pneumococcus, after influenza people have an increased risk of Staph pneumonia too. And Staph type bacteria are typically harder to treat than Strep due to widespread antibiotic resistance. Methicillin resistant staph aureus (MRSA) is on the rise. People can harbor the MRSA form of the bacteria somewhere in their body (such as in the nose) and show no signs of infection until something like influenza breaks down their body's resistance and the MRSA gets into the deeper tissues or blood. Then, they may develop a bacterial bronchitis or pneumonia which does not respond to the usual antibiotics . Since they are essentially not being treated, even though they are on antibiotics, they can get sicker or develop complications (like a collection of pus around the lung) and even die. People who have been in the hospital a lot or who come in close contact with people who have been in the hospital a lot and health care workers are more likely to carry MRSA. There are antibiotics which are effective against most strains of MRSA, but they are not the usual ones. You doctor has to think about MRSA and tailor your treatment to cover it if you suspect that you harbor the bug. So, do not take the left over antibiotics which your child used for an ear infection, assuming that one antibiotic is as good as any other. If you have had influenza and think that you are developing pneumonia, you need to see someone who can get you on the right drugs.

Note that antibiotics used for bacterial infections, like amoxicillin or augementin or ceftin, do not prevent or treat influenza. They only treat the secondary bacterial infections which can develop. So, just because your dad's doctor gave him a course of antibiotics when he got the flu, because your dad has an underlying problem like emphysema or chronic bronchitis that makes him always develop bacterial secondary infection, that does not mean that you need antibiotics for the flu. You may just need one of the anti-virals above.

How might a person know that they are developing bacterial pneumonia on top of influenza? If you get more short of breath, begin to have pains in your chest when you take a breath or start coughing up sputum that is discolored, or if you just start getting sicker, i.e too weak to leave the bed, can not keep down food, you may be developing a complication. People who are that sick need to get emergency treatment.

Probably, most people who get the swine flu will not get that sick. Many will not even get sick enough to go see a doctor. They will weather the infection and go back to work. However, the problem with any new strain of influenza, like this one, is that your body has no natural immunity to it at all. If you got a vaccine this year, it did nothing to make you stronger against the swine flu. We will all react like small children or infants to this new type of virus---and small kids get sicker with the flu, because their body has no "memory" of it that their immune systems can use to crank out disease fighting antibodies more quickly, the way that older kids and healthy adults do when they get flu for the 10th time. It is the bug's newness and the delay we will all experience before our bodies can finally start turning out the right antibody that will make it more serious.