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Appropriate Use of Oseltamivir in
the Treatment & Prophylaxis for
Influenza
Dr Ivan Hung
MBChB (Bristol) MD (HK) FRCP (Edi...
When should antivirals be given?
•  CDC recommendation
–  hospitalized
–  severe, complicated, or progressive illness
–  a...
Risk factors for severe influenza in host
•  Age
–  <2 years
–  >65 years old
•  Chronic underlying illness
–  chronic pul...
Classes of Antiviral
Neuraminidase Inhibitor
•  Oseltamivir
•  Zanamivir
•  Peramivir (FDA emergency
use expired June 2010...
Neuraminidase inhibitor
•  Oseltamivir, Zanamivir, Peramivir,
Laninamivir
•  Inhibits viral neuraminidase
–  Neuraminidase...
0
1
2
3
4
5
6
7
8
9
10
11
0 1 2 3 4 5 6 7 8 9
Days	
  after	
  symptom	
  onset
viral	
  load	
  (log10	
  copies/ml)
case...
Hsu J et al. Ann Intern Med 2012;156.
Hsu J et al. Ann Intern Med 2012;156.
Hsu J et al. Ann Intern Med 2012;156.
Jefferson T et al. BMJ 2009;339:b1506
Jefferson T et al. BMJ 2009;339:b1506
Jefferson T et al. BMJ 2009;339:b1506
Jefferson T et al. BMJ 2009;339:b1506
Jefferson T et al. BMJ 2009;339:b1506
Jefferson T et al. BMJ 2014;348
Lee N et al. Eur Respir J 2015;45:1642-52
Muthuri SG et al. Lancet Res Med 2014; 10.1016
Reduction in mortality risk:
NAI vs. none: OR 0.81; p=0.0024
NAI ≤2 days vs...
Dunning J et al. Lancet Infect Dis 2014;14:1259-70
Dunning J et al. Lancet Infect Dis 2014;14:1259-70
Dunning J et al. Lancet Infect Dis 2014;14:1259-70
Kim WY et al. AAC 2011
Hung IF et al. Chest 2013;144:464-73
Conclusions
•  Oseltamivir is effective for treatment &
prophylaxis of influenza infection
•  Low resistance rate
•  Limit...
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Appropriate Use of Oseltamivir in the Treatment & Prophylaxis for Influenza - Slide set by Professor Ivan Hung

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Professor Ivan Hung slide set on the effectiveness of Oseltamivir for the treatment and
prophylaxis of influenza infection in adults and children.

Veröffentlicht in: Gesundheit & Medizin
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Appropriate Use of Oseltamivir in the Treatment & Prophylaxis for Influenza - Slide set by Professor Ivan Hung

  1. 1. Appropriate Use of Oseltamivir in the Treatment & Prophylaxis for Influenza Dr Ivan Hung MBChB (Bristol) MD (HK) FRCP (Edin) FHKCP FHKAM (Medicine) PDipID Clinical Associate Professor Department of Medicine The University of Hong Kong
  2. 2. When should antivirals be given? •  CDC recommendation –  hospitalized –  severe, complicated, or progressive illness –  at higher risk for influenza complications •  Outbreak setting http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
  3. 3. Risk factors for severe influenza in host •  Age –  <2 years –  >65 years old •  Chronic underlying illness –  chronic pulmonary disease –  chronic cardiac disease –  metabolic disorders (esp. diabetes mellitus) –  chronic renal disease, chronic hepatic disease, certain neurological conditions –  Immunosuppression –  Children on chronic aspirin therapy: Reye syndrome •  Pregnancy (third/second trimester/<2 wk postpartum), IgG2 deficiency •  Obesity (delayed or impaired interferon, proinflammatory cytokine/chemokine, NK cytotoxicity, dendritic/CD8 T cell function in diet-induced obese mice) •  Chronic smoker
  4. 4. Classes of Antiviral Neuraminidase Inhibitor •  Oseltamivir •  Zanamivir •  Peramivir (FDA emergency use expired June 2010) •  Laninamivir (PIII) •  98.2% H1 susceptible to oseltamivir (H275Y); 100% susceptible to zanamvir •  100% H3 and flu B susceptibility Adamantanes •  Amantadine •  Rimantadine •  Almost 100% resistance Others: •  Viral RNA polymerase inhibitor (favipiravir T-705) •  Nitazoxanide: block maturation of viral hemagglutinin
  5. 5. Neuraminidase inhibitor •  Oseltamivir, Zanamivir, Peramivir, Laninamivir •  Inhibits viral neuraminidase –  Neuraminidase is required for the release of virus particle from the host cell surface •  Resistance increasing
  6. 6. 0 1 2 3 4 5 6 7 8 9 10 11 0 1 2 3 4 5 6 7 8 9 Days  after  symptom  onset viral  load  (log10  copies/ml) case control Days after symptom onset Number of patients with viral load checked on the particular day 0 1 2 3 4 5 6 7 8 9 Case (n = 110) 11 49 34 44 38 35 31 25 17 10 Control (n = 23) 6 12 4 9 5 11 11 7 4 3 Kruskal Wallis test: significant decreasing trend of mean viral load at D0–9 in case compared with control (p < 0.001). Viral load at D5 lower in cases (4.30 log10 vs 5.71 log10 copies/mL, p = 0.025). Initial VL correlates with symptom score p=0.05; Time of Rx initiation: 2.1 day post-symptom onset; Fever resolves 1.4 day earlier with oseltamivir Li IW, Hung IF et al. Chest. 2010 Apr;137(4):759-68
  7. 7. Hsu J et al. Ann Intern Med 2012;156.
  8. 8. Hsu J et al. Ann Intern Med 2012;156.
  9. 9. Hsu J et al. Ann Intern Med 2012;156.
  10. 10. Jefferson T et al. BMJ 2009;339:b1506
  11. 11. Jefferson T et al. BMJ 2009;339:b1506
  12. 12. Jefferson T et al. BMJ 2009;339:b1506
  13. 13. Jefferson T et al. BMJ 2009;339:b1506
  14. 14. Jefferson T et al. BMJ 2009;339:b1506
  15. 15. Jefferson T et al. BMJ 2014;348
  16. 16. Lee N et al. Eur Respir J 2015;45:1642-52
  17. 17. Muthuri SG et al. Lancet Res Med 2014; 10.1016 Reduction in mortality risk: NAI vs. none: OR 0.81; p=0.0024 NAI ≤2 days vs. >2 days: OR 0.48; p<0.0001
  18. 18. Dunning J et al. Lancet Infect Dis 2014;14:1259-70
  19. 19. Dunning J et al. Lancet Infect Dis 2014;14:1259-70
  20. 20. Dunning J et al. Lancet Infect Dis 2014;14:1259-70
  21. 21. Kim WY et al. AAC 2011
  22. 22. Hung IF et al. Chest 2013;144:464-73
  23. 23. Conclusions •  Oseltamivir is effective for treatment & prophylaxis of influenza infection •  Low resistance rate •  Limited by time of commencement •  Antiviral combination in severe cases

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