peramivir and Respiratory-Distress-Syndrome

Topics: Acids, Carbocyclic; Anti-Bacterial Agents; Antiviral Agents; Cholecystectomy; Cyclopentanes; Extracorporeal Membrane Oxygenation; Female; Guanidines; Herpesvirus 4, Human; Humans; Influenza A Virus, H7N9 Subtype; Middle Aged; Oseltamivir; Respiratory Distress Syndrome

Neuraminidase inhibitors (NAIs) including oseltamivir and peramivir are used for influenza treatment. A systemic corticosteroid is usually administrated for acute respiratory distress syndrome. The aim of this study was to investigate the effect of a systemic corticosteroid and its interaction with NAIs in patients with influenza infection and respiratory distress.. A retrospective survey of hospitalized patients infected with influenza from January 2012 to May 2014 was conducted in a medical center in Taiwan.. Eighty-six patients were hospitalized during the study period. Forty-eight patients had respiratory distress and 39 of them (81.3%, 39/48) were supported by a mechanical ventilator. All patients with respiratory distress received oseltamivir; 60.4% (29/48) and 31.3% (15/48) of them received a corticosteroid and salvage intravenous peramivir, respectively. All-cause mortality was 29.1% (14/48), 20% (3/15), and 31% (9/29) in patients with respiratory distress, patients who received salvage peramivir, and patients who received a systemic corticosteroid, respectively. Salvage peramivir seemed to improve prognosis in patients with H1pdm09 or type B virus infection and respiratory distress (p = 0.05). Early initiating corticosteroid had a worse prognosis than initiation after 72 hours of NAI treatment (p = 0.024). In particular, a systemic corticosteroid seemed to lead to a shorter survival time in patients with chronic lung disease (p = 0.05).. Salvage peramivir provided a better prognosis than monotherapy with oseltamivir in patients who were infected with H1pdm09 or type B virus and who developed respiratory distress. A systemic corticosteroid should be administered after initiating NAI therapy, especially in patients with chronic lung disease.

Topics: Acids, Carbocyclic; Adrenal Cortex Hormones; Aged; Aged, 80 and over; Antiviral Agents; Cyclopentanes; Drug Interactions; Drug Therapy, Combination; Enzyme Inhibitors; Female; Guanidines; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Male; Metabolic Syndrome; Middle Aged; Neuraminidase; Orthomyxoviridae; Oseltamivir; Respiratory Distress Syndrome; Retrospective Studies; Taiwan; Treatment Outcome

Since the novel H7N9 avian influenza outbreak occurred in China in 2013, neuraminidase inhibitors (NAIs) such as oseltamivir and peramivir have been used as first-line drugs to treat the influenza virus infection. This study aimed to compare the efficacy of oseltamivir-peramivir combination therapy versus oseltamivir monotherapy.. A retrospective study of 82 H7N9 confirmed patients was conducted by reviewing medical charts at the First Affiliated Hospital of ZheJiang University in China from April 1, 2013 to Feb 28, 2014. The patients' clinical information was collected systematically, and we compared the virology and clinical data between oseltamivir monotherapy group (43 patients) and oseltamivir-peramivir combination group (39 patients).. The median duration from NAIs administration to H7N9 virus-negative in oseltamivir monotherapy group and oseltamivir-peramivir combination group was 6.50 and 7.00 days (p >0.05), respectively. The median decline of Day 2 to Day 0 (initiation of NAIs therapy) viral load was 0.00 and 0.69 log10 copies/μl (p >0.05) respectively in the monotherapy vs. combination therapy groups. The incidence of new Acute Respiratory Distress Syndrome during NAI administration was 63.89 and 77.78 % (p >0.05); while the mortality rates were 25.58 and 43.59 % (p >0.05) in the oseltamivir group vs. oseltamivir-peramivir group.. Our results suggest that in adults with H7N9 virus infection, the use of oseltamivir-peramivir combination therapy was not superior to oseltamivir monotherapy.

Topics: Acids, Carbocyclic; Adolescent; Adult; Aged; Antiviral Agents; China; Cyclopentanes; Drug Therapy, Combination; Enzyme Inhibitors; Female; Guanidines; Humans; Influenza A Virus, H7N9 Subtype; Influenza, Human; Male; Middle Aged; Neuraminidase; Oseltamivir; Respiratory Distress Syndrome; Retrospective Studies; Viral Load; Young Adult

A 36-year-old man with underlying systemic lupus erythematosus complicated by autoimmune hemolytic anemia underwent immunosuppressive treatment. After showing a low-grade fever for two days, his fever spiked. He was confirmed to have pandemic (H1N1) 2009 by real-time reverse transcription polymerase chain reaction (PCR). His condition deteriorated to acute respiratory distress syndrome (ARDS), and mechanical ventilation became necessary. The lowest PaO(2)/FIO(2) ratio was 77, and he was placed on extracorporeal membrane oxygenation (ECMO). Based on our observation, the emergency use of ECMO in addition to peramivir might be useful. A noteworthy point is that once ARDS deteriorates due to pandemic (H1N1) 2009, intensive supportive care should be started.

Topics: Acids, Carbocyclic; Adult; Anemia, Hemolytic, Autoimmune; Antiviral Agents; Combined Modality Therapy; Cyclopentanes; Disease Outbreaks; Emergencies; Extracorporeal Membrane Oxygenation; Guanidines; Humans; Immunocompromised Host; Immunosuppressive Agents; Influenza A Virus, H1N1 Subtype; Influenza, Human; Lupus Erythematosus, Systemic; Male; Neuraminidase; Oxygen Inhalation Therapy; Prednisolone; Radiography; Respiration, Artificial; Respiratory Distress Syndrome; Viral Proteins