Table 2.

Treatment strategies for influenza disease at the Seattle Cancer Care Alliance

	First-line treatment	Second-line treatment	Research protocols
Asymptomatic shedding	Consider neuraminidase inhibitors (monotherapy)	No treatment, isolation, observe for development of symptoms	None
Upper respiratory infection	Oral/inhaled neuraminidase inhibitors (monotherapy)—dependent on circulating strain susceptibility	Oral/inhaled neuraminidase inhibitors (monotherapy)—alternative agent	Triple combination therapy vs monotherapy (phase 2)
Lower respiratory tract disease (no respiratory failure)	Oseltamivir (high dose) Consider IV peramivir. Consider combination therapy	Consider IVIG	IV zanamivir (phase 2)
Lower respiratory tract disease (respiratory failure, mechanical ventilation)	IV peramivir/zanamivir combination therapy	IVIG	None

Institutions comprising the Seattle Cancer Care Alliance are Fred Hutchinson Cancer Research Center, University of Washington, and Seattle Children's Hospital.

IVIG indicates intravenous immune globulin.