A Prospective Intervention Study on Higher-Dose Oseltamivir Treatment in Adults Hospitalized With Influenza A and B Infections
Publication in refereed journal


摘要Background. 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.
著者Lee N, Hui DSC, Zuo Z, Ngai KLK, Lui GCY, Wo SK, Tam WWS, Chan MCW, Wong BCK, Wong RYK, Choi KW, Sin WWY, Lee ELY, Tomlinson B, Hayden FG, Chan PKS
期刊名稱Clinical Infectious Diseases
頁次1511 - 1519
關鍵詞influenza,high dose,oseltamivir,treatment,viral clearance
Web of Science 學科類別Immunology;Infectious Diseases;Microbiology;Immunology;Infectious Diseases;Microbiology;IMMUNOLOGY;INFECTIOUS DISEASES;MICROBIOLOGY

上次更新時間 2021-24-02 於 01:51