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

Title
Triple-Combination Antiviral Drug for Pandemic H1N1 Influenza Virus Infection in Critically Ill Patients on Mechanical Ventilation
Author(s)
이관호김원영[김원영]서지영[서지영]허진운[허진운]김성한[김성한]김민주[김민주]김윤성[김윤성]김혜련[김혜련]류연주[류연주]한민수[한민수]고영관[고영관]천규락[천규락]최상호[최상호]홍상범[홍상범]
Keywords
A H1N1; H5N1 INFLUENZA; ADULT PATIENTS; OSELTAMIVIR; AMANTADINE; RIBAVIRIN; ZANAMIVIR; SAFETY; EFFICACY; THERAPY
Issue Date
201112
Publisher
AMER SOC MICROBIOLOGY
Citation
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, v.55, no.12, pp.5703 - 5709
Abstract
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.
URI
http://hdl.handle.net/YU.REPOSITORY/24179http://dx.doi.org/10.1128/AAC.05529-11
ISSN
0066-4804
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의과대학 > 내과학교실 > Articles
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