Treatment for Patients With Coinfection of Respiratory Infections
Expert panelists continue the discussion of treatment for patients with coinfection of respiratory diseases.
Tina Tan, MD: Then with coinfection, say, with flu and COVID-19, nobody really understands what the long-term adverse effects of that can be. It’s something we need to keep our eye on because these individuals could come out 2 or 3 months from now and pop up with some other symptom.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Do we give them both antiviral medications? Do we do that at the same time? That’s been a challenge for me, for the people who truly need them, do I give them together?
Tina Tan, MD: Yes.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: What’s the implication? I have, but what do we know about that in terms of efficacy?
Tina Tan, MD: Well, there’s no way for you to predict which one of these viruses is causing the bulk of what you’re seeing. But we know that if they’re sick enough to be hospitalized, you do need to treat them for both. Similarly, if they have progressive disease as an outpatient, you should be treating them for both.
Priya Nori, MD: I agree, Tina. I would say that in terms of cost-benefit, if they are at serious risk of death, then you should offer both treatments, is my personal feeling. Because the theoretical risk of some long-term damage from that combination of treatments or from something that we don’t anticipate at this point, I believe is less than the risk of them having seriously bad outcomes from their illness. So I wouldn’t have that be a hurdle to treatment. In fact, I worry about the hurdles we already have, whereby so many providers shy away from giving Paxlovid, so many providers shy away from giving molnupiravir. We know that these drugs are grossly underutilized, especially in our Black, Hispanic, and Latin X communities, where they have the highest risk of illness, yet aren’t being offered these agents, or are taking these agents in far lower frequency than we need them to have access to. So I wouldn’t use that as a hurdle to not treat.
Tina Tan, MD: JAM, when you think about using these 2 agents at the same time, from a pharmaceutical or pharmacy standpoint, do you see any reason that they should not be used? Are there any interactions we should be looking for?
Jacinda Abdul-Mutakabbir, PharmD: When I think about using drugs in combination I always first want to think about disease interaction. Are there any comorbidities that the patients might have? But when we think about antivirals, they are typically without big risk. If it were me, and I think Priya brought up a good point, at the end of the day, when it comes to thinking about theoretical risk and the risks that lie with the drugs, they often have a very favorable adverse effect profile. I would argue against using them both while we don’t have clinical studies that support this decision. But as someone who’s considering what collateral effects could be experienced, I would advocate for using them. I would advocate for treating the patient with both.
Tina Tan, MD: Kevin, in an outpatient urgent care setting, is it doable to maybe give a single dose of baloxavir and then start them on one of the COVID-19 medications?
Kevin Michael Reiter, MD, PA: Yes, I think it is. It was on our formulary at one time, the baloxavir, the Xofluza brand, and unfortunately, we were unable to access it this year. But I think that’s a great strategy. I think less is more. Just like when we are managing hypertension, or diabetes, HIV, we want to give patients fewer pills, less frequently, because we know that’s going to increase compliance. I think that’s a great strategy. It’s a great theoretic strategy, and hopefully, we can make that a reality in the coming months as we battle this coinfection and triple threat we’re dealing with right now.
Transcript edited for clarity
