Abstract | BACKGROUND: It is unclear if higher-dose oseltamivir provides benefit beyond the standard dose in influenza patients who require hospitalization. METHODS: A prospective intervention study was performed in 2 acute care general hospitals in Hong Kong over 4 seasonal peaks (2010-2012). Adults (≥18 years) with laboratory-confirmed influenza (85 A/H3N2, 34 A/H1N1pdm09, 36 B) infections who presented within 96 hours were recruited. Study regimen of either 150 mg or 75 mg oseltamivir twice daily for 5 days was allocated by site, which was switched after 2 seasons. Subjects with preexisting renal impairment ( creatinine clearance, 40-60 mL/minute) received 75 mg oseltamivir twice daily. Viral clearance by day 5 and clinical responses were compared between groups. Plasma steady-state trough oseltamivir carboxylate (OC) concentration was measured by high-performance liquid chromatography-tandem mass spectrometry. RESULTS: Altogether, 41 and 114 patients received 150 mg and 75 mg twice-daily oseltamivir, respectively; their enrollment characteristics (mean age, 61 ± 18 vs 66 ± 16 years) and illness severity were comparable. Trough OC levels were higher in the 150-mg group (501.0 ± 237.0 vs 342.6 ± 192.7 ng/mL). There were no significant differences in day 5 viral RNA (44.7% vs 40.2%) or culture negativity (100.0% vs 98.1%), RNA decline rate, and durations of fever, oxygen supplementation, and hospitalization. Results were similar when analyzed by study arm (all cases and among those without renal impairment). Subanalysis of influenza B patients showed faster RNA decline rate (analysis of variance, F = 4.14; P = .05) and clearance (day 5, 80.0% vs 57.1%) with higher-dose treatment. No oseltamivir resistance was found. Treatments were generally well tolerated. CONCLUSIONS: We found no additional benefit of higher-dose oseltamivir treatment in adults hospitalized with influenza A, but an improved virologic response in influenza B. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov, NCT01052961.
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Authors | N Lee, D S C Hui, Z Zuo, K L K Ngai, G C Y Lui, S K Wo, W W S Tam, M C W Chan, B C K Wong, R Y K Wong, K W Choi, W W Y Sin, E L Y Lee, B Tomlinson, F G Hayden, P K S Chan |
Journal | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
(Clin Infect Dis)
Vol. 57
Issue 11
Pg. 1511-9
(Dec 2013)
ISSN: 1537-6591 [Electronic] United States |
PMID | 24046309
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antiviral Agents
- Oseltamivir
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Topics |
- Aged
- Aged, 80 and over
- Antiviral Agents
(administration & dosage, blood, pharmacokinetics)
- Female
- Hong Kong
(epidemiology)
- Hospitalization
- Humans
- Influenza A virus
(isolation & purification)
- Influenza B virus
(isolation & purification)
- Influenza, Human
(drug therapy, epidemiology, virology)
- Male
- Middle Aged
- Nasopharynx
(virology)
- Oseltamivir
(administration & dosage, blood, pharmacokinetics)
- Prospective Studies
- Treatment Outcome
- Viral Load
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