Virulence may determine the necessary duration and dosage of oseltamivir treatment for highly pathogenic A/Vietnam/1203/04 influenza virus in mice

Background. Control of highly pathogenic avian H5N1 influenza viruses is a major public-health concern. Antiviral drugs could be the only option early in the pandemic. Methods. BALB/c mice were given oseltamivir (0.1, 1, or 10 mg/kg/day) twice daily by oral gavage; the first dose was given 4 h before inoculation with H5N1 A/Vietnam/1203/04 (VN1203/04) virus. Five- and 8-day regimens were evaluated. Results. Oseltamivir produced a dose-dependent antiviral effect against VN1203/04 in vivo (P < .01). The 5-day regimen at 10 mg/kg/day protected 50% of mice; deaths in this treatment group were delayed and indicated the replication of residual virus after the completion of treatment. Eight-day regimens improved oseltamivir efficacy, and dosages of 1 and 10 mg/kg/day significantly reduced virus titers in organs and provided 60% and 80% survival rates, respectively. Overall, the efficacy of the 5- and 8-day regimens differed significantly (death hazard ratio, P < .05 2.658;). The new H5N1 antigenic variant VN1203/04 was more pathogenic in mice than was A/HK/156/97 P < .01 virus, and a prolonged and higher-dose oseltamivir regimen may be required for the most beneficial antiviral effect. Conclusions. Oseltamivir prophylaxis is efficacious against lethal challenge with VN1203/04 virus in mice. Viral virulence may affect the antiviral treatment schedule.