CDC has issued a special advisory recognizing the almost universal oseltamivir
resistance of influenza A (H1N1) virus strains isolated so far this season in
the U.S.  Because the main influenza season has yet to begin, the predominant
strain that will circulate this winter is not yet known.

The advisory includes a complex table for the selection of antiviral treatment
depending on the known circulating virus locally and rapid antigen testing. CDC
recommends the use of zanamivir (Relenza) in most situations, unless the health
care provider has specific knowledge that the predominant virus circulating in
the community is H3N2 or B. Oseltamivir is not to be used for treatment in any
area where there is the knowledge or the suspicion that the virus in circulation
is H1N1.

In situations where zanamivir is unavailable, CDC is cautiously recommending
the unproven combination of oseltamivir plus rimantadine.  A Shoreland
assessment of the availability of zanamivir will be forthcoming.