First Dose Of Oseltamivir Research Articles

Oseltamivir-Associated Supraventricular Tachycardia in an Infant

Oseltamivir is a neuraminidase inhibitor that is labeled for prophylaxis and treatment of influenza. We describe a previously healthy 4-month-old infant who tested positive for influenza A and was started on oseltamivir. One hour after receiving his first dose of oseltamivir, the infant had a diaphoretic episode and appeared grey and clammy. The infant was subsequently seen by the primary care physician and referred for admission to the hospital. Approximately 40 minutes after the second dose of oseltamivir in the hospital, the infant's heart rate rose to greater than 300 bpm. An electrocardiogram was suggestive of supraventricular tachycardia. At the time of the event, the infant received 2 doses of adenosine, and oseltamivir was discontinued prior to transfer to a tertiary facility for a higher level of care.

Excess mortality is associated with influenza A (H1N1) in patients with severe acute respiratory illness

BackgroundAcute respiratory infections caused by viruses are among the leading causes of morbidity and mortality. The inflammatory response that follows viral infection is important for the control of virus proliferation. However, if overwhelming, may be associated with complicated outcomes. ObjectivesWe assessed the clinical characteristics of patients with severe acute respiratory illness (SARI) evolving to acute respiratory distress syndrome (ARDS) and the factors related to death. Study design. Prospective study in 273 adult patients with SARI performed in a university-affiliated 800-bed hospital serving an area of epidemiologic vigilance of 102 municipalities and more than 2 million inhabitants. Influenza A (H1N1) 2009 (A/H1N1), influenza A H3N2, and influenza B were tested in all patients by RT-PCR. ResultsThe overall hospital mortality rate was 17.6%. A total of 30.4% of patients tested positive for influenza A/H1N1. Patients with SARI that evolved to ARDS took significantly longer to take the first dose of oseltamivir (6.0 vs 1.0 days, p=0.002). Patients with H1N1 positive tests had almost 3 times higher probability of death, despite having significantly less comorbidities (p=0.027). The influenza A/H1N1 pdm09 vaccine reduced the odds of death by 78%. Nonsurvivors had a more intense inflammatory response than did survivors at 48 h (C-reactive protein: 31.0 ± 17.5 vs. 14.6 ± 8.9 mg/dl, p=0.001) as well as a more positive fluid balance. ConclusionsHospital mortality associated with influenza H1N1-associated SARI and ARDS continued to be high years after the 2009 pandemic in a population with low vaccine coverage. Antiviral treatment started more than two days after onset of symptoms was more frequently associated with ARDS and death and, having had vaccine against influenza A (H1N1) was a factor independently related to survival.

Clinical presentation, management and outcomes of influenza in Africa: systematic review, 2009-2014

Background: This paper aims to review the effectiveness of diagnostic and management of influenza in Africa, specifically mortality, treatment and outcomes. Methods & Materials: In two times, we searched the online databases PubMed™ and Scopus™ for articles and abstracts published in English and French between January 2003 and December 2014, with the following terms :(influenza OR flu) AND (clinical) AND (management OR outcomes) AND (Africa) at the first time, and online databases of internationals conferences for the abstract who do not meet the consent of the editor of scientific journals at the second time. Cross- sectional, longitudinal studies and randomized clinical trial on influenza were selected when clinical, management and outcomes were reported. Results: Patients with influenza were more likely to present with fever as initial and main symptom, followed by shortness of breathing, cough, muscle & joint pain, sore throat, hemoptysis, dyspnea, and gastrointestinal complaints (vomiting and diarrhea), pneumonic infiltrations in the chest. For the diagnostic nasal secretions were collected in patients presenting with flu syndrome and follow-up by laboratory identification of viruses was performed by the ELISA technique using anti-A and anti-B monoclonal antibodies (immunocapture) and by isolation on MDCK cells, quantitative real-time polymerase chain reaction (qRT-PCR) assay of the upper respiratory tract is used increasingly to diagnose lower respiratory tract infections. Amongst samples analyzed for influenza; 1–45% had laboratory-confirmed influenza infections; including influenza virus A (H3N2) type, A (H1N1) type, A (H5N1) type and influenza virus B. All confirmed cases received oseltamivir in any setting. Among groups known to be at high risk of influenza-associated complications, Included age<5 years, asthma, cardiac disease, pregnancy, diabetes mellitus, active pulmonary tuberculosis and chronic malnutrition. Mortality rate was 28 – 68.4%. Female sex, age>15 years, and receiving the first dose of oseltamivir>2 days after illness onset, non vaccination against the virus the circulating influenza, cardiovascular complications and ventilatory associated pneumonia were identified as mortality predicting factors. Conclusion: The classic presentation of influenza in Africa is most often confused with malaria, low technical platforms limit the detection of virus in the samples. The progressive creation of influenza sentinel surveillance system will improve care in Africa.

Correlation of days of illness on which oseltamivir was started with outcome in swine flu patients, in Government Medical College, Aurangabad (Jan-2015 to May 2015)

&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Background:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt; Since 2009, Government Medical College, Aurangabad, a tertiary care hospital in the Marathwada region of Maharashtra, India, has been regularly admitting cases of pneumonia and ARDS, that are labeled as swine flu suspects.&lt;/span&gt; Oseltamivir is effective in swine flu cases if given within 48 hours and better, within 24 hours of start of illness. However most of our patients do not get oseltamivir within 48 hours. Hence we decided to compare the outcome in patients who received oseltamivir within 48 hours and after that.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Methods:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt; This is an observational, cross-sectional study comparing the time lag between the start of symptoms and getting the first dose of oseltamivir. 59 H1N1 positive patients were admitted to the swine flu ward between January to May 2015. We compared the two groups, one that received oseltamivir within 48 hours of start of symptoms and one that received after 48 hours and compared it with the outcome, i. e survival or death.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Results: &lt;/span&gt;&lt;/strong&gt;38 patients (64.40%) in our study belonged to the age group of 31-50. Out of 59 positive patients, only 7 received oseltamivir within 48 hours, of whom 4 died. 52 received oseltamivir after 48 hours of whom 20 died. All the 11 who were given non-invasive ventilation, whereas only 1 of the 25 on invasive ventilation survived. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Conclusions: &lt;/span&gt;&lt;/strong&gt;Oseltamavir does not appear to have made a difference for survival whether it was given within 48 hours as compared to after 48 hours of onset of symptoms. However, these two groups were not comparable.&lt;/p&gt;

Effect of Oseltamivir on Bleeding Risk Associated with Warfarin Therapy

Warfarin is a commonly used oral anticoagulant and its interaction with other drugs can result in serious thrombotic or bleeding events. Currently, there is no definitive evidence on the possibility of an interaction between warfarin and oseltamivir. The objective of this study was to investigate whether a possible drug interaction between oseltamivir and warfarin exists. A retrospective review of patients on anticoagulation therapy who took oseltamivir from 1 September 2009 to 28 February 2010 at Seoul National University Hospital, Seoul, Korea, was carried out. Among 15 patients who were tested for prothrombin time/international normalized ratio (PT/INR) [hereafter referred to as INR] within 10 days of starting oseltamivir therapy and had previously stable INR values, seven patients had an increase in INR levels after oseltamivir administration, and the other eight patients maintained stable INR levels. The mean ± SD INR value was 2.08 ± 0.46 prior to the administration of oseltamivir and 5.15 ± 2.00 after treatment with oseltamivir (measured a mean ± SD 5.7 ± 2.5 days after the first dose of oseltamivir) in the INR-increased group and, respectively, 2.03 ± 0.40 and 1.97 ± 0.54 (measured 6.4 ± 2.5 days after the first dose of oseltamivir) in the INR-unaffected group. The dosage and duration of oseltamivir treatment were similar whether the INR values increased or not. There were bleeding events such as blood-tinged sputum and bloody ascites in three patients in the INR-increased group. The INR level recovered within 5 days after discontinuation of warfarin in these three patients. The positivity rates for influenza A H1N1 were not different between the INR-increased group and the INR-unaffected group. This case series suggests the possibility of a potential interaction between warfarin and oseltamivir. Further well designed prospective studies and genetic evaluations are needed to determine the exact nature of the interaction between warfarin and oseltamivir.

Clinical Course of Avian Influenza A(H5N1) in Patients at the Persahabatan Hospital, Jakarta, Indonesia, 2005–2008

BackgroundLimited understanding of the presentation and course of influenza A(H5N1) infection in humans hinders evidence-based management.MethodsWe reviewed the case records of patients admitted to the Persahabatan Hospital (RSP), Jakarta, Indonesia, with influenza A(H5N1) confirmed by real-time polymerase chain reaction.ResultsTwenty-two previously well patients, aged 3 to 47 years (median 24.5 years), were identified. All attended a clinic or hospital after a median of 2 days of illness (range 0–7). Times to first dose of oseltamivir (three died before receiving oseltamivir) were 2 to 12 days (median 7 days), administered mostly (n = 15) at RSP. Nineteen patients required mechanical ventilation. Deaths numbered 18 (case fatality = 82%) occurring within hours to 6 days of RSP admission, corresponding to 6 to 16 days of illness. Admission hyperglycemia (≥ 140 mg/dL), unrelated to steroids or known underlying diabetes mellitus, and elevated D-dimer levels (0.81–5.2 mg/L, upper limit of normal < 0.5 mg/L) were present in 14/21 (67%) and 20/21 (95%) patients, respectively. Fibrinogen concentrations were mostly low/normal at 129.9 to 517.9 mg/dL (median 241.1, normal 200–400 mg/dL), whereas C-reactive protein (9/11) and ferritin (6/8) levels were increased. Risk factors for death (univariate analysis) included: (1) increased D-dimers, (2) hyperglycema, (3) increased urea, (4) more extensive chest radiograph shadowing, and (5) lower admission oxygen saturation.ConclusionsEarly diagnosis and effective treatment of human influenza A(H5N1) infection remains challenging. Most patients were referred late with advanced disease. Oseltamivir had limited clinical impact. Elevated D-dimer levels, consistent with fibrinolysis, and hyperglycemia warrant more research to determine their underlying mechanisms and optimal treatment.

Zoonotic Transmission of Avian Influenza Virus (H5N1), Egypt, 2006–2009

During March 2006-March 2009, a total of 6,355 suspected cases of avian influenza (H5N1) were reported to the Ministry of Health in Egypt. Sixty-three (1%) patients had confirmed infections; 24 (38%) died. Risk factors for death included female sex, age > or = 15 years, and receiving the first dose of oseltamivir >2 days after illness onset. All but 2 case-patients reported exposure to domestic poultry probably infected with avian influenza virus (H5N1). No cases of human-to-human transmission were found. Greatest risks for infection and death were reported among women > or = 15 years of age, who accounted for 38% of infections and 83% of deaths. The lower case-fatality rate in Egypt could be caused by a less virulent virus clade. However, the lower mortality rate seems to be caused by the large number of infected children who were identified early, received prompt treatment, and had less severe clinical disease.

Clinical Effectiveness of Oseltamivir and Zanamivir for Treatment of Influenza A Virus Subtype H1N1 with the H274Y Mutation: A Japanese, Multicenter Study of the 2007–2008 and 2008–2009 Influenza Seasons

Influenza A virus subtype H1N1 with the H274Y mutation emerged and spread worldwide. However, the clinical effectiveness of the neuraminidase inhibitors, oseltamivir and zanamivir, has not been adequately reevaluated. Data from 164 patients with H1N1 virus infection and 59 patients with H3N2 virus infection during the 2008-2009 influenza season and 68 patients with H1N1 virus infection during the 2007-2008 influenza season who received a neuraminidase inhibitor were analyzed. The duration of fever (body temperature 37.5 degrees C) after the first dose of oseltamivir or zanamivir and from onset of symptoms was calculated from patient reports. The influenza virus was isolated, and its subtype was determined by hemagglutinin inhibition assay and polymerase chain reaction. The H274Y neuraminidase mutation status was determined by sequencing the neuraminidase segment. Of 68 patients with H1N1 virus infection during the 2007-2008 season, 41 were treated with oseltamivir, and 27 were treated with zanamivir. During the 2008-2009 season, 77 patients with H1N1 virus infection were treated with oseltamivir, and 87 were treated with zanamivir; 31 and 28 patients with H3N2 virus infection were treated with oseltamivir and zanamivir, respectively. All 49 analyzed H1N1 virus isolates obtained during the 2008-2009 season, but none of the isolates obtained during the 2007-2008 season, contained the H274Y mutation. The mean +/- standard deviation duration of fever after the start of oseltamivir therapy was significantly longer for patients with H1N1 virus infection (49.1+/-30.2 h) than it was for patients with H3N2 virus infection (33.7+/-20.1 h; P < .01) during the 2008-2009 season and patients with H1N1 virus infection during the 2007-2008 season (32.0+/-18.9 h; P < .001). The duration of fever was significantly longer after the first dose of oseltamivir than it was after the first dose of zanamivir for patients with H1N1 virus infection during the 2008-2009 season (P <.001). The duration of fever from onset of H1N1 virus infection was significantly longer for children 15 years of age during 2008-2009 (70.6+/-34.5 h) than it was for such children during 2007-2008 (48.4+/-21.2). The effectiveness of oseltamivir, but not that of zanamivir, decreased significantly for H1N1 virus infection during the 2008-2009 season.

A Comparison of the Effectiveness of Oseltamivir for the Treatment of Influenza A and Influenza B: A Japanese Multicenter Study of the 2003-2004 and 2004-2005 Influenza Seasons

To compare the effectiveness of oseltamivir for treatment of influenza A and influenza B, we conducted a prospective, multicenter study of the 2003-2004 and 2004-2005 influenza seasons. The study included 3351 patients in whom influenza had been diagnosed by use of an antigen detection test kit. Oseltamivir was administered to 1818 patients with influenza A and 1485 patients with influenza B. No anti-influenza drugs were administered to 21 patients with influenza A or to 27 patients with influenza B. Patients receiving oseltamivir therapy were divided into 4 groups according to the time between the onset of fever (temperature, > or = 37.5 degrees C) and administration of the first dose of oseltamivir (0-12 h, 13-24 h, 25-36 h, and 37-48 h). The patients were also divided into 4 subgroups on the basis of age (0-6 years, 7-15 years, 16-64 years, and >64 years). Virus isolation was performed after completion of oseltamivir therapy for 44 patients with influenza A and 31 patients with influenza B. The duration of fever was significantly shorter for patients with influenza A and B who were treated with oseltamivir than for patients who were not treated with an anti-influenza drug (P<.001 for both). The time until the patient became afebrile after the initial administration of oseltamivir and the duration of fever were significantly longer for patients with influenza B than for patients with influenza A for the 0-12 h, 13-24 h, 25-36 h, and 37-48 h groups (P<.001) and for all age groups (P<.001). After 4-6 days of oseltamivir therapy, the influenza B virus reisolation rate (51.6%) was significantly higher than the influenza A virus reisolation rate (15.9%) (P<.001). Oseltamivir is less effective for influenza B than for influenza A with regard to duration of fever and virus persistence, irrespective of patient age or the timing of administration of the first dose.