Triple-Combination Antiviral Drug for Pandemic H1N1 Influenza Virus Infection in Critically Ill Patients on Mechanical Ventilation

被引:48
作者
Kim, Won-Young [1 ]
Suh, Gee Young [4 ]
Huh, Jin Won [1 ]
Kim, Sung-Han [2 ]
Kim, Min-ju [3 ]
Kim, Yun Seong [5 ]
Kim, Hye-Ryoun [6 ]
Ryu, Yon Ju [7 ]
Han, Min Soo [8 ]
Ko, Young Gwan [9 ]
Chon, Gyu Rak [10 ]
Lee, Kwan Ho [11 ]
Choi, Sang-Ho [2 ]
Hong, Sang-Bum [1 ]
机构
[1] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Pulm & Crit Care Med, Seoul 138736, South Korea
[2] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Infect Dis, Seoul 138736, South Korea
[3] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Clin Epidemiol & Biostat, Seoul 138736, South Korea
[4] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Div Pulm & Crit Care Med, Seoul, South Korea
[5] Pusan Natl Univ, Sch Med, Pusan 609735, South Korea
[6] Korea Canc Ctr Hosp, Seoul, South Korea
[7] Ewha Womans Univ, Sch Med, Seoul, South Korea
[8] Eulji Univ, Sch Med, Taejon, South Korea
[9] Kyung Hee Univ, Sch Med, Seoul, South Korea
[10] Konkuk Univ, Sch Med, Cheungju, South Korea
[11] Yeungnam Univ, Coll Med, Taegu, South Korea
关键词
A H1N1; H5N1; INFLUENZA; ADULT PATIENTS; OSELTAMIVIR; AMANTADINE; RIBAVIRIN; ZANAMIVIR; SAFETY; EFFICACY; THERAPY;
D O I
10.1128/AAC.05529-11
中图分类号
Q93 [微生物学];
学科分类号
071005 ; 100705 ;
摘要
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.
引用
收藏
页码:5703 / 5709
页数:7
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