tetano
Editor, Senior Moderator
BMC Infect Dis. 2019 Oct 16;19(1):858. doi: 10.1186/s12879-019-4530-1. [h=1]Clinical outcomes of patients treated with intravenous zanamivir for severe influenza A(H1N1)pdm09 infection: a case report series.[/h]
Torti C[SUP]1[/SUP], Mazzitelli M[SUP]2[/SUP], Longhini F[SUP]3[/SUP], Garofalo E[SUP]3[/SUP], Bruni A[SUP]3[/SUP], Giancotti A[SUP]4[/SUP], Barreca GS[SUP]4[/SUP], Quirino A[SUP]4[/SUP], Liberto MC[SUP]4[/SUP], Serapide F[SUP]2[/SUP], Matera G[SUP]4[/SUP], Trecarichi EM[SUP]2[/SUP], Navalesi P[SUP]3[/SUP]; IMAGES (Integrated MAnaGEment of Sepsis) Group.
[h=3]Collaborators (12)[/h]
[h=3]Author information[/h] 1 Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, "Magna Graecia" University of Catanzaro, Catanzaro, Italy. torti@unicz.it. 2 Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, "Magna Graecia" University of Catanzaro, Catanzaro, Italy. 3 Department of Medical and Surgical Sciences, Unit of Intensive Care, "Magna Graecia" University, Catanzaro, Italy. 4 Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro, Italy.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Intravenous (IV) zanamivir could be a suitable alternative for the treatment of severe influenza A(H1N1)pdm09 infection in patients who are unable to take oral or inhaled medication, for example, those on mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, data on the clinical outcomes of such patients is limited.
[h=4]CASE PRESENTATION:[/h] We report the clinical outcomes of four patients who were admitted at the intensive care unit during the 2017-2018 influenza season with severe sepsis (SOFA score > 11) and acute respiratory distress syndrome requiring ECMO and mechanical ventilation. Two patients were immune-compromised. The A(H1N1)pdm09 genome was confirmed by polymerase chain reaction (PCR) on nasopharyngeal specimen swabs prior to administration of IV zanamivir at a dose of 600 mg twice daily. Weekly qualitative PCR analysis was done to monitor viral clearance, with zanamivir treatment being discontinued upon receipt of negative results. In addition, the patients were managed for concomitant multidrug-resistant bacterial infections, with infection resolution confirmed with blood cultures. The median time for zanamivir treatment was 10 days (IQR 10-17). The clinical outcome was favourable with all four patients surviving and improving clinically. All four patients achieved viral clearance of A(H1N1)pdm09 genome, and resolution of multidrug-resistant bacterial infections.
[h=4]CONCLUSIONS:[/h] IV zanamivir could be a good therapeutic option in patients with severe influenza A(H1N1)pdm09 infection who are unable to take oral or aerosolised antiviral medication. We recommend prospective randomized control trials to support this hypothesis.
[h=4]KEYWORDS:[/h] ECMO; ICU; Influenza A(H1N1)pdm09; Zanamivir
PMID: 31619209 DOI: 10.1186/s12879-019-4530-1
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Torti C[SUP]1[/SUP], Mazzitelli M[SUP]2[/SUP], Longhini F[SUP]3[/SUP], Garofalo E[SUP]3[/SUP], Bruni A[SUP]3[/SUP], Giancotti A[SUP]4[/SUP], Barreca GS[SUP]4[/SUP], Quirino A[SUP]4[/SUP], Liberto MC[SUP]4[/SUP], Serapide F[SUP]2[/SUP], Matera G[SUP]4[/SUP], Trecarichi EM[SUP]2[/SUP], Navalesi P[SUP]3[/SUP]; IMAGES (Integrated MAnaGEment of Sepsis) Group.
[h=3]Collaborators (12)[/h]
[h=3]Author information[/h] 1 Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, "Magna Graecia" University of Catanzaro, Catanzaro, Italy. torti@unicz.it. 2 Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, "Magna Graecia" University of Catanzaro, Catanzaro, Italy. 3 Department of Medical and Surgical Sciences, Unit of Intensive Care, "Magna Graecia" University, Catanzaro, Italy. 4 Department of Health Sciences, Unit of Clinical Microbiology, "Magna Graecia" University, Catanzaro, Italy.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Intravenous (IV) zanamivir could be a suitable alternative for the treatment of severe influenza A(H1N1)pdm09 infection in patients who are unable to take oral or inhaled medication, for example, those on mechanical ventilation and extracorporeal membrane oxygenation (ECMO). However, data on the clinical outcomes of such patients is limited.
[h=4]CASE PRESENTATION:[/h] We report the clinical outcomes of four patients who were admitted at the intensive care unit during the 2017-2018 influenza season with severe sepsis (SOFA score > 11) and acute respiratory distress syndrome requiring ECMO and mechanical ventilation. Two patients were immune-compromised. The A(H1N1)pdm09 genome was confirmed by polymerase chain reaction (PCR) on nasopharyngeal specimen swabs prior to administration of IV zanamivir at a dose of 600 mg twice daily. Weekly qualitative PCR analysis was done to monitor viral clearance, with zanamivir treatment being discontinued upon receipt of negative results. In addition, the patients were managed for concomitant multidrug-resistant bacterial infections, with infection resolution confirmed with blood cultures. The median time for zanamivir treatment was 10 days (IQR 10-17). The clinical outcome was favourable with all four patients surviving and improving clinically. All four patients achieved viral clearance of A(H1N1)pdm09 genome, and resolution of multidrug-resistant bacterial infections.
[h=4]CONCLUSIONS:[/h] IV zanamivir could be a good therapeutic option in patients with severe influenza A(H1N1)pdm09 infection who are unable to take oral or aerosolised antiviral medication. We recommend prospective randomized control trials to support this hypothesis.
[h=4]KEYWORDS:[/h] ECMO; ICU; Influenza A(H1N1)pdm09; Zanamivir
PMID: 31619209 DOI: 10.1186/s12879-019-4530-1
Free full text