Gert van der Hoek
In Memoriam - Editor, Senior Moderator
Experts divided on treatment for birdflu patients
Tue Jun 23, 2009
HONG KONG, June 23 (Reuters) - Experts on the H5N1 bird flu virus are divided on how to treat patients infected by the virus, which kills 60 percent of its victims.
In an article published in PLoS Medicine, Nicholas White at Mahidol University in Thailand argued that higher doses of the drug Tamiflu should be used to fight more resistant strains of the virus, but researchers in the United States said that would result in the virus becoming resistant.
The H5N1 has infected 433 people around the world since 2003, killing 262 of them, according to the latest tally by the World Health Organisation. The WHO recommends treating patients with Roche AG's (ROG.VX) Tamiflu at a dose of 75 mg twice daily for five days.
But White believes higher doses were needed because of the high fatality rate of H5N1.
"Rapidly fatal infections need urgent treatment with optimum doses of appropriate antimicrobials ... Inadequate initial treatment of life-threatening infections has serious consequences," White wrote.
"Common sense argues for recommending higher doses for such infections, at the expense of increased toxicity, to avoid any possibility of under-dosing those patients with unusual pharmacokinetics and more resistant organisms."
However, Robert Webster and Elena Govorkova from St. Jude Children's Research Hospital in the United States disagreed.
"The message is loud and clear that the strategy of relying on single anti-influenza drug treatment is wrong," they wrote.
Most seasonal strains of the H1N1 human influenza virus were already resistant to Tamiflu and they said "it would be foolish to continue being complacent and rely on monotherapy."
They added that doctors must consider instead a multidrug approach in treating H5N1 patients - for example, using Tamiflu together with another class of drugs called adamantanes.
They cited studies in mice, which showed such combination therapy inhibited H5N1 replication in the lungs and brains.
http://www.reuters.com/article/rbssHealthcareNews/idUST9254020090623
Tue Jun 23, 2009
HONG KONG, June 23 (Reuters) - Experts on the H5N1 bird flu virus are divided on how to treat patients infected by the virus, which kills 60 percent of its victims.
In an article published in PLoS Medicine, Nicholas White at Mahidol University in Thailand argued that higher doses of the drug Tamiflu should be used to fight more resistant strains of the virus, but researchers in the United States said that would result in the virus becoming resistant.
The H5N1 has infected 433 people around the world since 2003, killing 262 of them, according to the latest tally by the World Health Organisation. The WHO recommends treating patients with Roche AG's (ROG.VX) Tamiflu at a dose of 75 mg twice daily for five days.
But White believes higher doses were needed because of the high fatality rate of H5N1.
"Rapidly fatal infections need urgent treatment with optimum doses of appropriate antimicrobials ... Inadequate initial treatment of life-threatening infections has serious consequences," White wrote.
"Common sense argues for recommending higher doses for such infections, at the expense of increased toxicity, to avoid any possibility of under-dosing those patients with unusual pharmacokinetics and more resistant organisms."
However, Robert Webster and Elena Govorkova from St. Jude Children's Research Hospital in the United States disagreed.
"The message is loud and clear that the strategy of relying on single anti-influenza drug treatment is wrong," they wrote.
Most seasonal strains of the H1N1 human influenza virus were already resistant to Tamiflu and they said "it would be foolish to continue being complacent and rely on monotherapy."
They added that doctors must consider instead a multidrug approach in treating H5N1 patients - for example, using Tamiflu together with another class of drugs called adamantanes.
They cited studies in mice, which showed such combination therapy inhibited H5N1 replication in the lungs and brains.
http://www.reuters.com/article/rbssHealthcareNews/idUST9254020090623