tetano
Editor, Senior Moderator
First published October 2011, doi: 10.1128/AAC.05529-11 Antimicrob. Agents Chemother. December 2011 vol. 55 no. 12 5703-5709
Triple-Combination Antiviral Drug for Pandemic H1N1 Influenza Virus Infection in Critically Ill Patients on Mechanical Ventilation ?
Won-Young Kim1,?,
Gee Young Suh2,?,
Jin Won Huh1,
Sung-Han Kim3,
Min-ju Kim4,
Yun Seong Kim5,
Hye-Ryoun Kim6,
Yon Ju Ryu7,
Min Soo Han8,
Young Gwan Ko9,
Gyu Rak Chon10,
Kwan Ho Lee11,
Sang-Ho Choi3,
Sang-Bum Hong1,* and
for the Korean Society of Critical Care Medicine (KSCCM) H1N1 Collaborative?
+ Author Affiliations
1Department of Pulmonary and Critical Care Medicine
3Department of Infectious Diseases
4Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
2Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
5Pusan National University School of Medicine, Pusan, Republic of Korea
6Korea Cancer Center Hospital, Seoul, Republic of Korea
7Ewha Womans University School of Medicine, Seoul, Republic of Korea
8Eulji University School of Medicine, Daejon, Republic of Korea
9School of Medicine, Kyung Hee University, Seoul, Republic of Korea
10Konkuk University School of Medicine, Cheungju, Republic of Korea
11College of Medicine, Yeungnam University, Daegu, Republic of Korea
ABSTRACT
A recent in vitro study showed that the three compounds of antiviral drugs with different mechanisms of action (amantadine, ribavirin, and oseltamivir) could result in synergistic antiviral activity against influenza virus. However, no clinical studies have evaluated the efficacy and safety of combination antiviral therapy in patients with severe influenza illness. A total of 245 adult patients who were critically ill with confirmed pandemic influenza A/H1N1 2009 (pH1N1) virus infection and were admitted to one of the intensive care units of 28 hospitals in Korea were reviewed. Patients who required ventilator support and received either triple-combination antiviral drug (TCAD) therapy or oseltamivir monotherapy were analyzed. A total of 127 patients were included in our analysis. Among them, 24 patients received TCAD therapy, and 103 patients received oseltamivir monotherapy. The 14-day mortality was 17% in the TCAD group and 35% in the oseltamivir group (P = 0.08), and the 90-day mortality was 46% in the TCAD group and 59% in the oseltamivir group (P = 0.23). None of the toxicities attributable to antiviral drugs occurred in either group of our study, including hemolytic anemia and hepatic toxicities related to the use of ribavirin. Logistic regression analysis indicated that the odds ratio for the association of TCAD with 90-day mortality was 0.58 (95% confidence interval, 0.24 to 1.42; P = 0.24). Although this study was retrospective and did not provide virologic outcomes, our results suggest that the treatment outcome of the triple combination of amantadine, ribavirin, and oseltamivir was comparable to that of oseltamivir monotherapy.
http://aac.asm.org/content/55/12/5703.short?rss=1
Triple-Combination Antiviral Drug for Pandemic H1N1 Influenza Virus Infection in Critically Ill Patients on Mechanical Ventilation ?
Won-Young Kim1,?,
Gee Young Suh2,?,
Jin Won Huh1,
Sung-Han Kim3,
Min-ju Kim4,
Yun Seong Kim5,
Hye-Ryoun Kim6,
Yon Ju Ryu7,
Min Soo Han8,
Young Gwan Ko9,
Gyu Rak Chon10,
Kwan Ho Lee11,
Sang-Ho Choi3,
Sang-Bum Hong1,* and
for the Korean Society of Critical Care Medicine (KSCCM) H1N1 Collaborative?
+ Author Affiliations
1Department of Pulmonary and Critical Care Medicine
3Department of Infectious Diseases
4Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
2Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
5Pusan National University School of Medicine, Pusan, Republic of Korea
6Korea Cancer Center Hospital, Seoul, Republic of Korea
7Ewha Womans University School of Medicine, Seoul, Republic of Korea
8Eulji University School of Medicine, Daejon, Republic of Korea
9School of Medicine, Kyung Hee University, Seoul, Republic of Korea
10Konkuk University School of Medicine, Cheungju, Republic of Korea
11College of Medicine, Yeungnam University, Daegu, Republic of Korea
ABSTRACT
A recent in vitro study showed that the three compounds of antiviral drugs with different mechanisms of action (amantadine, ribavirin, and oseltamivir) could result in synergistic antiviral activity against influenza virus. However, no clinical studies have evaluated the efficacy and safety of combination antiviral therapy in patients with severe influenza illness. A total of 245 adult patients who were critically ill with confirmed pandemic influenza A/H1N1 2009 (pH1N1) virus infection and were admitted to one of the intensive care units of 28 hospitals in Korea were reviewed. Patients who required ventilator support and received either triple-combination antiviral drug (TCAD) therapy or oseltamivir monotherapy were analyzed. A total of 127 patients were included in our analysis. Among them, 24 patients received TCAD therapy, and 103 patients received oseltamivir monotherapy. The 14-day mortality was 17% in the TCAD group and 35% in the oseltamivir group (P = 0.08), and the 90-day mortality was 46% in the TCAD group and 59% in the oseltamivir group (P = 0.23). None of the toxicities attributable to antiviral drugs occurred in either group of our study, including hemolytic anemia and hepatic toxicities related to the use of ribavirin. Logistic regression analysis indicated that the odds ratio for the association of TCAD with 90-day mortality was 0.58 (95% confidence interval, 0.24 to 1.42; P = 0.24). Although this study was retrospective and did not provide virologic outcomes, our results suggest that the treatment outcome of the triple combination of amantadine, ribavirin, and oseltamivir was comparable to that of oseltamivir monotherapy.
http://aac.asm.org/content/55/12/5703.short?rss=1