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お医者さん
お医者さん

インフルエンザの予防投与はするべきか?~医師へのアンケートより

医者

“インフルエンザの予防投与”という言葉をお聞きになったことがありますか?これは、実際にインフルエンザに罹患する前に、抗インフルエンザ薬を服用することでインフルエンザに罹ることを予防しよう、という方法です。

「仕事は休めないから、インフルエンザが流行ってきたら予防投与して貰えると助かる!」「予防投与にかかる費用ってどれくらいなの?」などなど、様々な声が聞こえてきそうですね。

本記事では、インフルエンザの予防投与に対する医師へのアンケートを基に、インフルエンザの予防投与のメリット、デメリットについて、考えてみましょう。

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インフルエンザの予防投与について~医師へのアンケート

女性

抗インフルエンザ薬の予防投与を職員に対して行っているか、医師へ行ったアンケート(メドピア株式会社によるアンケート)があります。

このアンケートの結果、6割以上は抗インフルエンザ薬の予防投与は行っていないことがわかりました。一方、3割ほどの医師は、職員全員、または一部職員に予防投与を行っていると回答しています。

それでは、それぞれどのような理由が挙がっているのか、ご紹介しましょう。

【抗インフルエンザ薬の予防投与は行わないとする理由】

  • 耐性を作ることになる
  • 発症してからで十分効果がある
  • インフルエンザワクチンの投与を行うべきである
  • インフルエンザの流行期間中ずっと内服が必要となり、現実的ではない
  • 副作用のリスクを忘れてはいけない。本当に必要な状況だけに限定すべき

【抗インフルエンザ薬の予防投与を行うとする理由】

  • 妊婦や抗がん剤投与をしている患者さんを診ているので、必要
  • 感染のリスクが高い部署で行う
  • 職員の家族にインフルエンザ患者が出た場合に予防投与を行う
  • 院内発症の拡大防止のため、職員全員に投与する

このアンケートは、“病院の職員に対して予防投与を行うか?”という少し特殊な内容ではありますが、以上にみてきた意見のなかには、一般的な予防投与について考える際にも参考となるものがあります。

それでは次に、上記アンケートの意見のなかから、抗インフルエンザ薬の予防投与のメリット、デメリットを考えてみましょう。

抗インフルエンザ薬の予防投与を行うときのメリット

上記のアンケートで、抗インフルエンザ薬の予防投与を行う理由として、「感染リスクが高い部署で」「家族にインフルエンザ患者が出た場合」など、インフルエンザへの感染予防の効果が挙げられています。

インフルエンザへの感染のリスクが高いと判断される場合、実際にインフルエンザの症状が出ていなくても、予防的に抗インフルエンザ薬を投与することで、発症を抑えようとする考え方です。

インフルエンザには潜伏期間があり、実際にインフルエンザウイルスに感染しても発症するまでには時間差があります。一方、抗インフルエンザ薬はインフルエンザウイルスの体内での増殖を抑える作用のある薬です。このため、インフルエンザウイルスに感染しているリスクが高い場合は、発症する前=ウイルスが体内で増殖する前に抗インフルエンザ薬を投与することで、発症を抑える、または重症化を防ぐことができるのです。

抗インフルエンザ薬の予防投与を行うときのデメリット

それでは次に、アンケートの意見から、抗インフルエンザ薬を予防投与することのデメリットについて、考えてみましょう。

服用期間

インフルエンザが流行しはじめたから、などの理由で予防投与を行う場合、インフルエンザの流行中はずっと抗インフルエンザ薬を服用することになります。

実際にインフルエンザを発症した場合の抗インフルエンザ薬の服用期間を5日程度と考えると、予防投与で服用する期間は、これに比べると相当長い期間ということができるでしょう。

耐性

耐性とは、細菌やウイルスに対して、薬剤の効果がなくなった状態をさします。

インフルエンザウイルスは、変異のスピードが非常に速いため、抗ウイルス薬を用いると、一定割合で耐性ウイルスが発生し、使用していた抗ウイルス薬が効かなくなってしまうのです。

このように、必要以上に抗インフルエンザ薬を使用すると耐性ウイルスが発生する、という危険性が考えられます。

副作用

薬を服用する場合に、注意しなくてはならないのが副作用です。

現在、抗インフルエンザ薬として一般的に処方されているタミフルは、吐き気、嘔吐、腹痛、下痢などの胃腸症状が副作用として現れる場合があります。

また、特異なケースで因果関係もはっきりとしていませんが、タミフルの服用後の幻覚や異常行動による事故事例も発生しています。

費用

抗インフルエンザ薬の予防投与は、保険適応外となるため、全額自費負担となります。

タミフルを1日1回1カプセル、10日間服用した場合、かかる費用は6500円程度です。

まとめ:抗インフルエンザ薬の予防投与はメリット、デメリットを考えて

抗インフルエンザ薬の予防投与には、メリット、デメリットの両面があるため、個人の状況にあわせて選ぶことが大切です。

それではここで、もう一度抗インフルエンザ薬の予防投与のメリット、デメリットをまとめてみましょう。

【抗インフルエンザ薬の予防投与のメリット】
・インフルエンザ発症の予防

【抗インフルエンザ薬の予防投与のデメリット】

  • 服用期間が長い
  • 耐性を作る可能性
  • 副作用の可能性
  • 費用が高い

インフルエンザは発症してしまうとかなりつらい症状に苦しんだり、場合によっては重い合併症を引き起こしたりすることもあります。インフルエンザの予防投与について迷うようなときは、このようなインフルエンザの危険性と、抗インフルエンザ薬の予防投与のメリット、デメリットを考え合わせ、どうするべきか判断していただければと思います。

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Check Also

考える

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  インフルエンザと症状のよく …

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