Triple-Combination Antiviral Drug for Pandemic H1N1 Influenza Virus Infection in Critically Ill Patients on Mechanical Ventilation
Open Access
- 1 December 2011
- journal article
- research article
- Published by American Society for Microbiology in Antimicrobial Agents and Chemotherapy
- Vol. 55 (12), 5703-5709
- https://doi.org/10.1128/aac.05529-11
Abstract
A recentin vitrostudy 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.Keywords
This publication has 38 references indexed in Scilit:
- Clinical Experience in Adults and Children Treated with Intravenous Peramivir for 2009 Influenza A (H1N1) Under an Emergency IND Program in the United StatesClinical Infectious Diseases, 2011
- Efficacy of Oseltamivir-Zanamivir Combination Compared to Each Monotherapy for Seasonal Influenza: A Randomized Placebo-Controlled TrialPLoS Medicine, 2010
- Rapid Selection of a Transmissible Multidrug‐Resistant Influenza A/H3N2 Virus in an Immunocompromised HostThe Journal of Infectious Diseases, 2010
- Triple Combination of Amantadine, Ribavirin, and Oseltamivir Is Highly Active and Synergistic against Drug Resistant Influenza Virus Strains In VitroPLOS ONE, 2010
- Critically Ill Patients With 2009 Influenza A(H1N1) Infection in CanadaJAMA, 2009
- Effects of Double Combinations of Amantadine, Oseltamivir, and Ribavirin on Influenza A (H5N1) Virus Infections in Cell Culture and in MiceAntimicrobial Agents and Chemotherapy, 2009
- Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in SpainCritical Care, 2009
- Oseltamivir Is Adequately Absorbed Following Nasogastric Administration to Adult Patients with Severe H5N1 InfluenzaPLOS ONE, 2008
- APACHE II-A Severity of Disease Classification SystemCritical Care Medicine, 1986
- APACHE IICritical Care Medicine, 1985