There continues to be a lot of influenza activity in our area and in the province. To date, 23 outbreaks of influenza A have been reported in Middlesex-London. These have included outbreaks in hospitals, nursing homes, retirement homes and assisted living facilities.

As previously mentioned in an email on December 19, 2012, nursing homes and many retirement homes have processes such as medical directives for rapidly providing oseltamivir (Tamiflu) prophylaxis and/or treatment to residents during an influenza outbreak. This may not always be the case in some retirement homes and assisted living facilities. Should antiviral medications be recommended in facilities without these processes, community physicians may be asked to prescribe oseltamivir for their patients who are residents of these facilities. The attached document provides information to assist in the prescription of oseltamivir. Should you have residents in these facilities, you may want to consider providing a prescription in advance in case an outbreak is declared in the facility.

Please note that when prescribing oseltamivir, it is not necessary to know the resident’s creatinine values. If the resident is not known to have renal impairment, then the standard dosages can be used as follows:

• Treatment for those residents who are ill with influenza-like symptoms: 75 mg twice daily for 5 days (which can be extended if needed)
• Prophylaxis for residents who do not have influenza-like symptoms in the facility: 75 mg once daily for 14 days (the Health Unit is recommending 14 days for prophylaxis although some guidelines indicate that 10 days is also acceptable).

If you have any questions, please do not hesitate to contact me at 519-663-5317 ext. 2427

Bryna