A prospective intervention study on higherdose oseltamivir treatment in adults hospitalized with influenza A and B infections
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AbstractBackground. It is unclear if higher-dose oseltamivir provides benefit beyond the standard dose in influenza patients who require hospitalization. Methods. A prospective intervention study was performed in 2 acute care general hospitals in Hong Kong over 4 seasonal peaks (2010-2012). Adults (≥18 years) with laboratory-confirmed influenza (85 A/H3N2, 34 A/H1N1pdm09, 36 B) infections who presented within 96 hours were recruited. Study regimen of either 150 mg or 75 mg oseltamivir twice daily for 5 days was allocated by site, which was switched after 2 seasons. Subjects with preexisting renal impairment (creatinine clearance, 40-60 mL/minute) received 75 mg oseltamivir twice daily. Viral clearance by day 5 and clinical responses were compared between groups. Plasma steady-state trough oseltamivir carboxylate (OC) concentration was measured by high-performance liquid chromatography-tandem mass spectrometry. Results. Altogether, 41 and 114 patients received 150 mg and 75 mg twice-daily oseltamivir, respectively; their enrollment characteristics (mean age, 61 ± 18 vs 66 ± 16 years) and illness severity were comparable. Trough OC levels were higher in the 150-mg group (501.0 ± 237.0 vs 342.6 ± 192.7 ng/mL). There were no significant differences in day 5 viral RNA (44.7% vs 40.2%) or culture negativity (100.0% vs 98.1%), RNA decline rate, and durations of fever, oxygen supplementation, and hospitalization. Results were similar when analyzed by study arm (all cases and among those without renal impairment). Subanalysis of influenza B patients showed faster RNA decline rate (analysis of variance, F = 4.14; P = .05) and clearance (day 5, 80.0% vs 57.1%) with higher-dose treatment. No oseltamivir resistance was found. Treatments were generally well tolerated. Conclusions. We found no additional benefit of higher-dose oseltamivir treatment in adults hospitalized with influenza A, but an improved virologic response in influenza B. © The Author 2013.
All Author(s) ListLee N., Hui D.S.C., Zuo Z., Ngai K.L.K., Lui G.C.Y., Wo S.K., Tam W.W.S., Chan M.C.W., Wong B.C.K., Wong R.Y.K., Choi K.W., Sin W.W.Y., Lee E.L.Y., Tomlinson B., Hayden F.G., Chan P.K.S.
Journal nameClinical Infectious Diseases
Year2013
Month12
Day1
Volume Number57
Issue Number11
PublisherUniversity of Chicago Press
Place of PublicationUnited States
Pages1511 - 1519
ISSN1058-4838
eISSN1537-6591
LanguagesEnglish-United Kingdom
KeywordsHigh dose, Influenza, Oseltamivir, Treatment, Viral clearance

Last updated on 2020-22-10 at 02:40