Cideous Posted January 18, 2018 Share Posted January 18, 2018 Guess I am in the minority. I treat with Tamiflu unless otherwise contraindicated. 1st of all most pt's in Urgent Care expect the script, and if they don't get it......Bad review. Something that can not happen. Our corporate overlords will then have "the talk..." with the provider. Secondly, goodness help you if you see someone within 48 hours of the flu, don't give them Tamiflu and they end up with pneumonia/organ failure and die. Right Wrong or something in between...you will lose that lawsuit. Before everyone goes nuts about right is right and wrong is wrong......I agree, but medicine is littered with these stupid compromises we make every day. I just don't think this is the issue to fall on your sword over. Now antibiotics for URI's.....sure. Link to comment Share on other sites More sharing options...
beattie228 Posted January 18, 2018 Share Posted January 18, 2018 48 minutes ago, Cideous said: Guess I am in the minority. I treat with Tamiflu unless otherwise contraindicated. 1st of all most pt's in Urgent Care expect the script, and if they don't get it......Bad review. Something that can not happen. Our corporate overlords will then have "the talk..." with the provider. Secondly, goodness help you if you see someone within 48 hours of the flu, don't give them Tamiflu and they end up with pneumonia/organ failure and die. Right Wrong or something in between...you will lose that lawsuit. Before everyone goes nuts about right is right and wrong is wrong......I agree, but medicine is littered with these stupid compromises we make every day. I just don't think this is the issue to fall on your sword over. Now antibiotics for URI's.....sure. I follow the same suit. I'll often print the prescription and staple it to their check out. I'll give the spiel of "I printed a prescription for Tamiflu in case you need it. If it were me or a loved one, I wouldn't advise you take it. It'll decrease your symptoms by about 10 hours on average, but with a host of potential side effects". If people fill it after they leave, so be it. Link to comment Share on other sites More sharing options...
PA-SGuy Posted January 18, 2018 Share Posted January 18, 2018 How much does Tamiflu run patients? quick search online said $80-$130. At that price, I don't expect many ppl would actually fill it. Link to comment Share on other sites More sharing options...
BruceBanner Posted January 18, 2018 Share Posted January 18, 2018 1 hour ago, Cideous said: Guess I am in the minority. I treat with Tamiflu unless otherwise contraindicated. 1st of all most pt's in Urgent Care expect the script, and if they don't get it......Bad review. Something that can not happen. Our corporate overlords will then have "the talk..." with the provider. Secondly, goodness help you if you see someone within 48 hours of the flu, don't give them Tamiflu and they end up with pneumonia/organ failure and die. Right Wrong or something in between...you will lose that lawsuit. Before everyone goes nuts about right is right and wrong is wrong......I agree, but medicine is littered with these stupid compromises we make every day. I just don't think this is the issue to fall on your sword over. Now antibiotics for URI's.....sure. Flu is getting scary this year, and media has been going crazy about it. Lots of previously healthy young people (not just babies and the old) getting secondary PNA, then sepsis, then dead. Just google "flu 2018". Historically I never give Tamiflu unless they demand it, but now in light of all this I'm giving it for all but the mildest cases. Risk:benefit. Link to comment Share on other sites More sharing options...
MikeyBoy Posted January 18, 2018 Share Posted January 18, 2018 Bad year so far. Had a handful of Flu A+ patients end up on ECMO last month, and we rarely refer patients for ECMO. This past week we have been having steadily more patients testing +. Critically ill, waiting on the viral panel= I start tamiflu. No question about it. Even if >2-3days. Link to comment Share on other sites More sharing options...
thinkertdm Posted January 18, 2018 Share Posted January 18, 2018 What is the relationship between influenza severity and getting the vaccine? Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 19, 2018 Share Posted January 19, 2018 And this is the recommendation. If in house and treatment would be impacted do the test (one of the more sensitive ones). I swear the world thinks rapid test results are engraved in stone and won’t consider other facts. Link to comment Share on other sites More sharing options...
jen0508 Posted January 22, 2018 Share Posted January 22, 2018 On 1/18/2018 at 1:30 PM, PA-SGuy said: How much does Tamiflu run patients? quick search online said $80-$130. At that price, I don't expect many ppl would actually fill it. It's generic now (since end of 2016). It was $10 when I filled it couple weeks ago. No longer Tier 2. You can print Good Rx coupon for people without insurance , it will be around $50-60 Link to comment Share on other sites More sharing options...
jen0508 Posted January 22, 2018 Share Posted January 22, 2018 Last time I checked Up-to-date , they recommend treating at risk patients even outside of 48h window and even if rapid flu test is negative (if sx consistent with flu) In healthy patients , I dont treat if sx greater than 48h. If under 48h, I discuss risk vs benefits and let them decide. Our ID peeps say flu swab only 30-70% percent sensitive this year. So remember.. negative test does not rule it out Bad season in my neck of the woods. I have about 5-10 positive tests a day. Lots of pt without fever and minor sx testing positive (our triage nurses test pretty much every body lol). No biggie for the young healthy pts, but scary that these people with minor sx are walking around thinking they just have a cold and spreading to at risk pts. We have a lot of flu admissions this year...elderly especially. Full hospitals , lots of ER boarders, long ED wait times... ? Link to comment Share on other sites More sharing options...
SedRate Posted January 22, 2018 Share Posted January 22, 2018 A lot of cases here, too. EDs are overrun and going on rolling divert. State Dept of Health sent out a message stating 10x the amount of cases this season as compared to last season. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 22, 2018 Share Posted January 22, 2018 Be careful with the young adult “walking well” since they succumb as well which is why all the hubbub. Bell curve extremes die each flu season. Link to comment Share on other sites More sharing options...
sk732 Posted January 22, 2018 Share Posted January 22, 2018 We're having elective surgeries in our tertiary centres cancelled because no normal beds and no ICU beds if someone needs stepdown, courtesy of Enza flying in...a lot. SK Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 22, 2018 Share Posted January 22, 2018 One advantage of an associate who tests everything is that you run out and then can’t test anyone! Oh no! We have to use clinical acumen! Link to comment Share on other sites More sharing options...
SCPA Posted January 25, 2018 Share Posted January 25, 2018 thoughts on the family member of your flu pt who wants tamiflu prophy? Legalities if said family member is not your patient? Link to comment Share on other sites More sharing options...
marktheshark89 Posted January 25, 2018 Share Posted January 25, 2018 Make them come in for a visit. Need to have a face to face to review their chart, medical history, make sure they dont already have the flu (as treatment would be different), and discuss risks and benefits of ppx. Link to comment Share on other sites More sharing options...
thinkertdm Posted January 25, 2018 Share Posted January 25, 2018 The heading for this topic reminds me of this: Quote Yo, I don't think we should talk about this(Come on, why not?)People might misunderstand what we're tryin' to say, you know?(No, but that's a part of life)Come on Let's talk about you and meLet's talk about all the good thingsAnd the bad things that may beLet's talk about fluLet's talk about fluLet's talk about fluLet's talk about flu Let's talk about flu for nowTo the people at home or in the crowdIt keeps coming up anyhowDon't decoy, avoid, or make void the topicCause that ain't gonna stop itNow we talk about flu on the radio and video showsMany will know, anything goesLet's tell it like it is, and how it could beHow it was, and of course, how it should beThose who think it's dirty have a choicePick up the needle, press pause, or turn the radio offWill that stop us, Pep? I doubt itAll right then, come on, Spin... Link to comment Share on other sites More sharing options...
camoman1234 Posted January 25, 2018 Share Posted January 25, 2018 14 hours ago, SCPA said: thoughts on the family member of your flu pt who wants tamiflu prophy? Legalities if said family member is not your patient? Make them est. care. End of story. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted January 29, 2018 Moderator Share Posted January 29, 2018 As a policy, we've stopped doing rapid flu tests for patients being discharged. If they are admitted, we swab for the flu- if it ends up being negative (which as as lot of you pointed out, is occurring frequently), then it automatically reflexes to the NAT test for confirmation. For discharge, I'm under no pressure to either prescribe or not prescribe tamiflu. I **always** have that talk with patients regarding cost, potential side effects, and how little it affects duration of illness- but if they're high risk, I still give it to them because as others have pointed out, potential secondary issues such as sepsis or bacterial pneumonia could be devastating Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 29, 2018 Share Posted January 29, 2018 11 minutes ago, True Anomaly said: As a policy, we've stopped doing rapid flu tests for patients being discharged. If they are admitted, we swab for the flu- if it ends up being negative (which as as lot of you pointed out, is occurring frequently), then it automatically reflexes to the NAT test for confirmation. For discharge, I'm under no pressure to either prescribe or not prescribe tamiflu. I **always** have that talk with patients regarding cost, potential side effects, and how little it affects duration of illness- but if they're high risk, I still give it to them because as others have pointed out, potential secondary issues such as sepsis or bacterial pneumonia could be devastating Potential secondary issue to add: The attorney letter in the daily mail wanting to discuss why it wasn't prescribed? The legal emblem on the envelope says MMQ and Assoc. (Monday morning quarterback). Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted February 6, 2018 Share Posted February 6, 2018 I almost never prescribe Tamiflu for all the reasons mentioned above. For the pt's I admit from the ED, the hospitalists are wanting Tamiflu, no matter the duration of s/s, so I do. I did find out that there is an IV version of Tamiflu, peramivir. I ordered it once on a patient too ill for orals. Turns out we don't have it in my hospital's pharmacy - it had to come from the mother ship. Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 8, 2018 Moderator Share Posted February 8, 2018 First confirmed case in my facility. Secure 200 population. Adults No fevers but aches and felt ill + flu B treated per our protocol tamiflu (waste imho but in protocol) and isolation. ugh sorry off op topic Link to comment Share on other sites More sharing options...
camoman1234 Posted February 8, 2018 Share Posted February 8, 2018 1 hour ago, ventana said: First confirmed case in my facility. Secure 200 population. Adults No fevers but aches and felt ill + flu B treated per our protocol tamiflu (waste imho but in protocol) and isolation. ugh sorry off op topic RHC clinic, town of 600, solo private practice, I have had ~40 + flu A or B with most of those linked to another virus such as coronavirus, human metapneumovirus, parainfluenza, and adenovirus all in 2 weeks :( I have been wearing a mask ALL day long! :) Link to comment Share on other sites More sharing options...
lkth487 Posted February 8, 2018 Share Posted February 8, 2018 Have had lots of cases this year in peds: in clinic, floor and ICU. Only one instance where we gave tamiflu. I've been seeing some myocarditis too, with significantly depressed heart function. Link to comment Share on other sites More sharing options...
camoman1234 Posted February 8, 2018 Share Posted February 8, 2018 11 hours ago, lkth487 said: Have had lots of cases this year in peds: in clinic, floor and ICU. Only one instance where we gave tamiflu. I've been seeing some myocarditis too, with significantly depressed heart function. What is your threshold on Tamiflu in peds? I would like to hear your guidelines, expertise and your thoughts on psychiatric symptoms due to Tamiflu. Link to comment Share on other sites More sharing options...
lkth487 Posted February 8, 2018 Share Posted February 8, 2018 That's easy - I don't use it. I've used it only a handful of times in super critically ill peds patients but overall, it's such a stupid drug. Like for intubated kids, people talk about IV version, but there's no benefit: https://www.ncbi.nlm.nih.gov/m/pubmed/25115871/ For the oral version, the only times I've used it was in confirmed cases of pediatric influenza where the sx began less than 72 hours ago AND the child was high risk (not just by age as the CDC defines it but due to other factors such as, premature lungs, a genetic immunodeficiency or a baby with HIV for example). I personally don't find the data compelling enough to justify the use of the medication vs the side effects. Link to comment Share on other sites More sharing options...
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