Giuseppe
Emeritus
Emergence of Oseltamivir-Resistant Pandemic H1N1 Virus during Prophylaxis (NEJM, extract, edited)
Emergence of Oseltamivir-Resistant Pandemic H1N1 Virus during Prophylaxis
To the Editor:
Neuraminidase inhibitors (oseltamivir and zanamivir) are recommended for treatment of severe illness caused by the 2009 pandemic influenza A (H1N1) virus, and their use has also been advocated for postexposure prophylaxis in high-risk persons.1 We report the emergence of an oseltamivir-resistant virus in a familial cluster of infections with the 2009 H1N1 virus.
In a 13-year-old boy with asthma, infection with the 2009 H1N1 virus developed and was confirmed by reverse-transcriptase polymerase-chain-reaction (RT-PCR) testing of a nasopharyngeal aspirate. Administration of oseltamivir (60 mg twice a day for 5 days for this boy who weighed 32 kg) was begun, and the patient was discharged home the same day. Simultaneous with treatment of the index patient, postexposure prophylaxis with oseltamivir (75 mg once a day for 10 days) was prescribed to all household contacts (the boy's 59-year-old father, who had chronic obstructive pulmonary disease and was taking prednisone at a dose of 5 mg daily; 50-year-old mother; and 15-year-old and 18-year-old sisters). Approximately 24 hours after oseltamivir prophylaxis was begun, influenza-like symptoms developed in the father (Figure 1). On day 8 of oseltamivir prophylaxis, the father consulted his general practitioner because of persistent cough. A nasopharyngeal aspirate collected at that time was positive for the 2009 H1N1 virus, according to RT-PCR testing and culture. The father had an uneventful clinical course, and a nasopharyngeal aspirate sampled at the end of his illness was negative for the 2009 H1N1 virus. Influenza-like symptoms did not develop in any other household contacts.
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<cite cite="http://content.nejm.org/cgi/content/full/NEJMc0910060?query=TOC">NEJM -- Emergence of Oseltamivir-Resistant Pandemic H1N1 Virus during Prophylaxis</cite>To the Editor:
Neuraminidase inhibitors (oseltamivir and zanamivir) are recommended for treatment of severe illness caused by the 2009 pandemic influenza A (H1N1) virus, and their use has also been advocated for postexposure prophylaxis in high-risk persons.1 We report the emergence of an oseltamivir-resistant virus in a familial cluster of infections with the 2009 H1N1 virus.
In a 13-year-old boy with asthma, infection with the 2009 H1N1 virus developed and was confirmed by reverse-transcriptase polymerase-chain-reaction (RT-PCR) testing of a nasopharyngeal aspirate. Administration of oseltamivir (60 mg twice a day for 5 days for this boy who weighed 32 kg) was begun, and the patient was discharged home the same day. Simultaneous with treatment of the index patient, postexposure prophylaxis with oseltamivir (75 mg once a day for 10 days) was prescribed to all household contacts (the boy's 59-year-old father, who had chronic obstructive pulmonary disease and was taking prednisone at a dose of 5 mg daily; 50-year-old mother; and 15-year-old and 18-year-old sisters). Approximately 24 hours after oseltamivir prophylaxis was begun, influenza-like symptoms developed in the father (Figure 1). On day 8 of oseltamivir prophylaxis, the father consulted his general practitioner because of persistent cough. A nasopharyngeal aspirate collected at that time was positive for the 2009 H1N1 virus, according to RT-PCR testing and culture. The father had an uneventful clinical course, and a nasopharyngeal aspirate sampled at the end of his illness was negative for the 2009 H1N1 virus. Influenza-like symptoms did not develop in any other household contacts.
(...)
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