Antiviral therapeutics for pediatric influenza, COVID-19, herpes

Transcript:

Ashley Gyura, DNP, CPNP-PC:

Hi, I'm Ashley Gyura, I am a pediatric nurse practitioner and I specialize in infectious diseases Children's Minnesota.

Contemporary Pediatrics:

Can you tell us about your session, “Antiviral Therapeutics for Pediatric Primary and Acute Care (Rx),”presented at NAPNAP 2024?

Gyura:

I presented this year on antivirals, there seemed to be a gap this year on some of the sessions, and so I wanted to make sure that anyone new to practice or even people who have been practicing for a long time got the updates that were needed for antivirals within pediatric primary and acute care. [My session was] an overview of the ones that we've been using for many years, but sometimes people can forget about them or are not sure how to use them.

We went over pretty much the basic antivirals that you might use for normal viral infections that you might see in pediatrics. We looked at the safety and efficacy and dosing guidelines for those, and then looked at which medications we might use for specific viral infections. We also did a little bit of talking about what we see for emerging trends and future directions within antiviral therapeutics.

One of the things that we initially focused on was influenza and the antivirals that are available, which are oseltamivir, or Tamiflu, and baloxavir. One of the questions I received from several people was the neuropsychiatric effects that can happen with oseltamivir.

I think that, especially in social media, we certainly know that oseltamivir can have neuropsychiatric side effects, but there was also a study done in 2023 [that] looked at how many serious neuropsychiatric events happened in kids who have influenza, both with and without antivirals.

It was interesting because these events do happen in kids who aren't taking antivirals and so I think that will help us know how to move forward looking at the events with oseltamivir.

In a healthy kiddo, it's a conversation that you have with your patients. In kiddos who have a high risk of having severe influenza, the risk generally does not outweigh the benefit of getting oseltamivir, so we talked about that quite a bit.

Starting to seem more states test for congenital CMV, within their newborn blood spots, Minnesota was the first state to do that, which is where I'm based, and we started doing it early last year. Soon, Connecticut will follow in 2025 and New York is doing a pilot study for one year on testing DBS for congenital CMV. Remembering how we treat CMV and what kids are qualifying for treatment was another thing that we talked about, I think one of the biggest things that I'd like to impress is that there will be changes on this information and the 2024 red book. So I won't really get into exactly what the recommendations are now, because that will probably change come May when their 2024 red book comes out. But as more and more states start to test for congenital CMV, that will become more and more important for pediatric primary care providers to know the recommendations for medication, who qualifies for medication and the workup that's needed if they get a positive on that test.

We talked a little bit about the antivirals that we use right now for COVID, which specifically for children, we use primarily Paxlovid and remdesivir. Nothing specific has changed with those two medications other than with the Paxlovid emergency use authorization, there was a letter in January that changed the authorization for the emergency use authorization for Paxlovid, but it didn't actually affect using the medication under the EUA for those age groups. So the age groups that is under EUA for are greater than 12 years or greater than 40 kilos and then it is FDA approved for 18 and older. So really, that affects our kiddos but it doesn't change how we can prescribe it. It just changes, how the pharmacy kind of uses up what they had and then what they're supposed to use moving forward. So I think sometimes people can be a little bit confused about the what that meant. But clinically, it really didn't change anything about who we can prescribe it to.

The other few things we talked about were what antiviral drugs that we use in herpes infections. There's haven't been a ton of changes there. There are a lot of different options based on patient preference, timing, what kind of episode they're having for herpes, whether it's a genital first outbreak, stomatitis, or recurrent outbreaks and that is for the provider and the patient to determine what would be the best option because there are several options. We also talked a little bit about pre-exposure prophylaxis for HIV. PrEP is something that I think can easily be done and encouraged in primary care. The only big update is we now have an injectable pre-exposure prophylaxis medication, which is great. So that makes 3 options that providers can use to try to prevent their adolescent patients from getting HIV, which includes Truvada, Descovy, and Apretude, which is the injectable medication and only needs to be given every 2 months, which is amazing. So those are the big updates and some of the things that we reviewed as well.

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