BACKGROUND: We performed a randomized trial of 2 protocols guiding the duration of antiviral chemoprophylaxisduring outbreaks of influenza A in a rural, 700-bed nursing home for veterans and their spouses with 14 nursing units in 4 buildings. METHODS: Half of all residents volunteered to participate. Nursing units were randomized, and the effectiveness of short-term (minimum, 14 days and 7 days without the onset of a case in the building) vs long-term (minimum, 21 days and 7 days without the onset of a case in the 4-building facility) prophylaxis was compared using amantadine hydrochloride in the influenza seasons of 1991-1992 and 1993-1994 andrimantadine hydrochloride in the influenza season of 1994-1995. A "case" is defined as an incident of a respiratory tract illness and the isolation of an influenza virus organism. We compared the number of cases after the discontinuation of short- vs long-term chemoprophylaxis. Prospective surveillance identified residents with new respiratory tract symptoms, and specimens for viral cultures were obtained even in the absence of temperature elevation. RESULTS: We documented influenza A virus activity during 3 seasons (32, 68, and 12 patients, respectively). During the 1991-1992, 1993-1994, and 1994-1995 influenza seasons, the patients on 11 floors were assigned to receive short-term chemoprophylaxis and those on 10 floors were assigned to long-term chemoprophylaxis. Only in 1993-1994 did chemoprophylaxis extend beyond 14 or 21 days when new cases continued beyond 14 days. Amantadine-resistant strains were circulating at that time. None of the participants in the prospective, controlled study had influenza develop after the termination of short- or long-term chemoprophylaxis. CONCLUSION:Antiviral chemoprophylaxis can be administered for the longer duration of 14 days or, in the absence of new culture-confirmed illness in the nursing building, for 7 days.
RCT Entities:
BACKGROUND: We performed a randomized trial of 2 protocols guiding the duration of antiviral chemoprophylaxis during outbreaks of influenza A in a rural, 700-bed nursing home for veterans and their spouses with 14 nursing units in 4 buildings. METHODS: Half of all residents volunteered to participate. Nursing units were randomized, and the effectiveness of short-term (minimum, 14 days and 7 days without the onset of a case in the building) vs long-term (minimum, 21 days and 7 days without the onset of a case in the 4-building facility) prophylaxis was compared using amantadine hydrochloride in the influenza seasons of 1991-1992 and 1993-1994 and rimantadine hydrochloride in the influenza season of 1994-1995. A "case" is defined as an incident of a respiratory tract illness and the isolation of an influenza virus organism. We compared the number of cases after the discontinuation of short- vs long-term chemoprophylaxis. Prospective surveillance identified residents with new respiratory tract symptoms, and specimens for viral cultures were obtained even in the absence of temperature elevation. RESULTS: We documented influenza A virus activity during 3 seasons (32, 68, and 12 patients, respectively). During the 1991-1992, 1993-1994, and 1994-1995 influenza seasons, the patients on 11 floors were assigned to receive short-term chemoprophylaxis and those on 10 floors were assigned to long-term chemoprophylaxis. Only in 1993-1994 did chemoprophylaxis extend beyond 14 or 21 days when new cases continued beyond 14 days. Amantadine-resistant strains were circulating at that time. None of the participants in the prospective, controlled study had influenza develop after the termination of short- or long-term chemoprophylaxis. CONCLUSION: Antiviral chemoprophylaxis can be administered for the longer duration of 14 days or, in the absence of new culture-confirmed illness in the nursing building, for 7 days.
Authors: Timothy M Uyeki; Henry H Bernstein; John S Bradley; Janet A Englund; Thomas M File; Alicia M Fry; Stefan Gravenstein; Frederick G Hayden; Scott A Harper; Jon Mark Hirshon; Michael G Ison; B Lynn Johnston; Shandra L Knight; Allison McGeer; Laura E Riley; Cameron R Wolfe; Paul E Alexander; Andrew T Pavia Journal: Clin Infect Dis Date: 2019-03-05 Impact factor: 9.079
Authors: F M Munoz; G J Galasso; J M Gwaltney; F G Hayden; B Murphy; R Webster; P Wright; R B Couch Journal: Antiviral Res Date: 2000-05 Impact factor: 5.970
Authors: Márcia G Alves Galvão; Marilene Augusta Rocha Crispino Santos; Antonio J L Alves da Cunha Journal: Cochrane Database Syst Rev Date: 2014-11-21
Authors: Scott A Harper; John S Bradley; Janet A Englund; Thomas M File; Stefan Gravenstein; Frederick G Hayden; Allison J McGeer; Kathleen M Neuzil; Andrew T Pavia; Michael L Tapper; Timothy M Uyeki; Richard K Zimmerman Journal: Clin Infect Dis Date: 2009-04-15 Impact factor: 9.079
Authors: Adam L Gordon; Phillipa A Logan; Rob G Jones; Calum Forrester-Paton; Jonathan P Mamo; John R F Gladman Journal: BMC Geriatr Date: 2012-06-25 Impact factor: 3.921
Authors: Joe B Silva; Elliott Bosco; Daniela N Quilliam; Stefan Gravenstein; Andrew R Zullo Journal: J Am Med Dir Assoc Date: 2020-07-11 Impact factor: 7.802