Epidemiological survey on the benefit of neuraminidase inhibitors on severe acute respiratory syndrome due to COVID-19 / Levantamento epidemiológico do benefício de inibidores de neuraminidase na síndrome respiratória aguda grave por COVID-19 / Encuesta epidemiológica del beneficio de inhibidores de neuraminidase en síndrome respiratorio agudo severo por COVID-19

Background and objectives: The COVID-19 pandemic and its consequent severe acute respiratory syndrome (SARS) have taken the lives of millions since 2020. The use of neuraminidase inhibitors is a promising alternative in treating this disease, with several studies on off-label use being conducted since the beginning of the pandemic, but none of them have a large sample size and analyze multiple risk factors. The purpose of this article is to identify possible associations between various factors and risk of hospitalization, need for ventilation and death, as well as the influence of the prescription of Zanamivir and Oseltamivir on these same indicators. Methods: In this transversal study, approximately 900,000 medical records from all regions of Brazil were collected from the Ministry of Health database, and after that, proper statistical analysis of the variables was performed. Results: Hospitalization was associated with gender, ethnicity, education, local urbanization, State, and its percentage of elderly, as well as the climate. The prescription of Zanamivir and Oseltamivir was associated with higher incidence of symptoms, lower hospitalization and death rate, and lower need for invasive and non-invasive ventilation. Medical records from146,160 patients were excluded due to SARS not caused by COVID-19. Conclusion: From this data, it is possible to draw a risk profile for hospitalization by SARS and consider the use of Zanamivir and Oseltamivir as a treatment for these patients.(AU)

Justificativa e objetivos: A pandemia de COVID-19 e sua consequente síndrome respiratória aguda grave (SRAG) levaram milhões de pessoas a óbito desde 2020. O uso de inibidores da neuraminidase é uma alternativa promissora no tratamento dessa doença, com vários estudos sobre o uso off-label sendo conduzidos desde o início da pandemia, mas nenhum que tenha um grande tamanho amostral e que analise vários fatores de risco. O objetivo deste artigo é identificar possíveis associações entre diversos fatores e risco de hospitalização, necessidade de ventilação e óbito, assim como a influência da prescrição de Zanamivir e Oseltamivir nos mesmos indicadores. Métodos: Neste estudo transversal, foi feito o levantamento de aproximadamente 900 mil prontuários de todas as regiões do Brasil, provenientes de dados do Ministério da Saúde, e em seguida foi realizado o tratamento estatístico adequado das variáveis. Resultados: A hospitalização foi associada a sexo, etnia, escolaridade, urbanização do local, Estado e porcentagem de idosos do mesmo, assim como o clima. Já a prescrição de Zanamivir e Oseltamivir foi associada a maior incidência de sintomas, menor taxa de hospitalização e óbito e menor necessidade de ventilação invasiva e não-invasiva. Foram excluídos 146.160 prontuários devido a SRAG não ocasionada pela COVID-19. Conclusão: Com esses dados, é possível traçar um perfil de risco para hospitalização por SRAG e considerar o uso de Zanamivir e Oseltamivir como tratamento para esses pacientes.(AU)

Justificación y objetivos: la pandemia Covid-19 y su consiguiente síndrome respiratorio agudo severo (SRAS) han muerto millones de personas desde 2020. El uso de inhibidores de la neuraminidasa es una alternativa prometedora en el tratamiento de esta enfermedad, con varios estudios sobre el uso off-label que se realiza desde el principio de la pandemia, pero ninguno que tenga un tamaño de muestra grande y analice múltiples factores de riesgo. El propósito de este artículo es identificar posibles asociaciones entre varios factores y el riesgo de hospitalización, necesidad de ventilación y muerte, así como la influencia de la prescripción de Zanamivir y Oseltamivir en los mismos indicadores. Métodos: En este estudio transversal, se encuestaron a los datos del Ministerio de Salud de aproximadamente 900,000 registros de todas las regiones de Brasil, después de que se realizó un tratamiento estadístico adecuado de las variables. Resultados: La hospitalización se asoció con género, etnia, educación, urbanización del sitio, Estado y porcentaje de ancianos, así como el clima. La prescripción de zanamivir y oseltamivir se asoció con la mayor incidencia de síntomas, menor hospitalización y tasa de mortalidad y menor necesidad de ventilación invasiva y no invasiva. Se excluyeron 146,160 registros médicos debido a SRAS no causado por Covid-19. Conclusión: con estos datos, es posible dibujar un perfil de riesgo para la hospitalización por SRAS y considerar el uso de zanamivir y oseltamivir como tratamiento para estos pacientes.(AU)

Síndrome Respiratória Aguda Grave por Influenza A/B: Análise da Situação Vacinal / Severe Acute Respiratory Syndrome due to Influenza A/B: Analysis of Vaccination Status

Introdução: A Influenza é uma doença respiratória altamente contagiosa, prevenível por vacinação, afetando todos os grupos etários,com morbidade e mortalidade variáveis. O objetivo deste estudo foi analisar a relação da situação vacinal dos pacientes com Influenza A/B atendidos com Síndrome Respiratória Aguda Grave. Métodos: Estudo retrospectivo, a partir das notificações do Sistema de Informação de Agravos de Notificação Compulsório do Brasil, de pacientes com esquema vacinal conhecido para Influenza A/B em um hospital-escola do interior do Rio Grande do Sul (2012 a 2018). Resultados: Foram incluídos 596 casos de SRAG, sendo 179 (30,0%) por vírus respiratórios [92 (51,4%) Influenza A/B e 87 (48,6%) outros vírus respiratórios]. Na faixa etária de maiores de 50 anos, a frequência foi 28,2%, 6 meses a 1 ano foi de 19,6%, seguido de 13% no grupo etário de 2 a 4 anos. O esquema vacinal estava completo em 59,8% dos casos, sendo que em 37,5% dos pacientes apresentavam esquema vacinal incompleto. O tratamento antiviral foi administrado em 90,2% do pacientes com SRAG por Influenza A/B, e a alta hospitalar ocorreu em 91,3% dos casos. Conclusão: A vacinação é uma estratégia para prevenção de complicações relacionadas à Influenza. No entanto, a SRAG é uma apresentação com diagnóstico diferencial amplo, e as causas virais necessitam de confirmação para uma otimização da terapêutica antiviral. A equipe de saúde deve estar atenta a pacientes com riscos de SRAG, a fim de minimizar os desfechos negativos, mesmo nos vacinados.

Introduction: Influenza is a highly contagious respiratory disease, preventable by vaccination, affecting all age groups, with variable morbidity and mortality. The objective of this study was to analyze the relationship between the vaccination status of Influenza A/B patients seen with Severe Acute Respiratory Syndrome. Methods: Retrospective study, from notifications of the Brazilian Compulsory Notification Agencies Information System (Sistema de Informação de Agravos de Notificação Compulsório do Brasil), of patients with known vaccination schemes for Influenza A/B in a teaching hospital in the interior of Rio Grande do Sul (2012 to 2018). Results: Of the 596 cases of SARS included, 179 (30.0%) were due to respiratory viruses [92 (51.4%) Influenza A/B and 87 (48.6%) other respiratory viruses]. In the age group over 50 years, the frequency was 28.2%, from 6 months to 1 year old was 19.6%, followed by 13% in the age group of 2 to 4 years. The vaccination schedule was complete in 59.8% of cases, with 37.5% having an incomplete vaccination scheme. Antiviral treatment was administered in 90.2% of the patients with SARS by Influenza A/B, and hospital discharge occurred in 91.3% of the cases. Conclusion: Vaccination is a strategy to prevent complications related to Influenza. However, SARS is a presentation with wide differential diagnosis, and the viral causes need confirmation for an optimization of the antiviral therapy. The healthcare team must be aware of patients at risk of SARS to minimize negative outcomes, even in vaccinated patients.

Efficacy of oseltamivir compared with zanamivir in COPD patients with seasonal influenza virus infection: a randomized controlled trial

Influenza viruses exacerbate chronic obstructive pulmonary disease (COPD) with considerable morbidity and mortality. Zanamivir and oseltamivir are effective in treating influenza. However, their efficacy in relieving influenza symptoms in COPD patients remains unknown, with the lack of controlled trials in this subject. Therefore, we conducted this randomized controlled trial to investigate the clinical efficacy of both interventions in this population. Patients were allocated to two groups (80 patients each): oseltamivir (OSELTA) and zanamivir (ZANA) groups. Oseltamivir (75 mg) was orally administered twice daily for 5 days, while zanamivir (10 mg) was inhaled twice daily for 5 days. Clinical parameters including body temperature, influenza symptoms (i.e., sore throat, cough, etc.), and serial blood tests were recorded on days 1, 3, and 7. We analyzed primary (changes in body temperature) and secondary outcomes (changes in non-specific symptoms) using the pre-protocol and intention-to-treat analyses. Differences between groups were assessed using t-test. Oseltamivir and zanamivir significantly reduced body temperature on the 3rd day after treatment; however, the number of patients who reported clinical improvement in influenza-like symptoms was significantly higher in the OSELTA group compared to the ZANA group on days 3 (85 vs 68.8%, P=0.015) and 7 (97.5 vs 83.8%, P=0.003). However, no significant changes in hematological (white blood cells and its subtypes) and inflammatory (C-reactive protein) parameters were noted (P>0.05). Our results suggested that oseltamivir and zanamivir are effective in reducing body temperature, while oseltamivir led to better clinical improvement regarding influenza-like symptoms in patients with COPD.

Meta analysis if the efficacy and safety of Lianhua Qingwen capsule versus oseltamivir in the treatment of influenza / 药学实践杂志

Objective To evaluate the efficacy and safety of Llianhua Qingwen capsule versus oseltamivir in the treatment of influenza. Methods Data from PubMed, Cochrane Library, Embase, VIP, CNKI and CBM, RCTs about Lianhua Qingwen capsule or Lianhua Qingwen capsule combined with other drugs (trial group) versus oseltamivir (control group) in the influenza were collected. The outcome indicators such as the effective rate of extraction, the time for viral nucleic acid to become negative, the time for fever and the time for symptom resolution, etc., were used for Meta analysis with RevMan 5.3 statistical software. Results Totally 14 studies were included, involving 1459 patients. The Meta analysis results showed that there was no significant difference in the therapeutic effect, the time of virus turning negative and defervescence, and fever reduction time in the experimental group compared with the control group. In terms of symptom relief, the effect of cough and headache resolution in the experimental group was better than that in the control group, and the difference was statistically significant. There was no significant difference in the time to subside of general muscle soreness and pharyngeal pain in the test group and the control group. In terms of safety, there was no statistically significant difference in the incidence of adverse reactions between the experimental group and the control group. Conclusion Lianhua Qingwen capsule is similar to oseltamivir phosphate in curative effect and adverse reaction rate in the treatment of influenza, and is superior to oseltamivir in relieving cough and headache symptoms.

Uso do Oseltamivir em Síndromes Respiratórias: revisão sistemática rápida / Use of Oseltamivir in Respiratory Syndromes: a quick systematic review

Contexto: Os vírus da gripe são importantes patógenos globais, cujas taxas de incidência resultam em substancial incidência de doenças, hospitalização e mortalidade. O oseltamivir é um medicamento comumente usado e armazenado contra pandemias passadas e futuras com base em normas internacionais e recomendações nacionais. O tratamento preconizado pela OrganizaÇão Mundial de Saúde (OMS), para casos graves de influenza, é o oseltamivir. A infecção pelo novo coronavírus (COVID-19) apresenta sintomas respiratórios, os quais exigem o diagnóstico laboratorial SARS-CoV-2; sendo orientada8 a administração de Oseltamivir em casos de Síndrome Respiratória Aguda Grave (SRAG) sem diasgnóstico até resultado de RT-PCR. Objetivos: Identificar evidências científicas quanto ao uso do oseltamivir no tratamento de síndromes respiratórias. Método: Revisão sistemática rápida (rapid review methodology) nas bases de dados PUBMED e Cochrane Library. Resultados: Do total de 41 revisões sistemáticas identificadas, foram incluídas 13 publicações, referente a 12 estudos desenvolvidos. Conclusão: Com base nos achados nesta revisão sistemática rápida, o oseltamivir apresenta desempenho modesto no que se refere à eficácia no tratamento e na profilaxia da gripe.(AU)

Glyphosate on shikimic acid on Urochloa plantaginea / Efeito do glifosato no ácido chiquímico em Urochloa plantaginea

ABSTRACT: Shikimic acid (SA) has witnessed a strong increase in recent years due to the increasing demand of the pharmaceutical and cosmetic industry. The SA is used as a precursor for the synthesis of oseltamivir phosphate (Tamiflu®), a potent viral inhibitor and is extracted from the plant Illicium verum Hook which has a limited availability. This article proposed the use of Urochloa plantaginea (Link.) webster and glyphosate, as an alternative source of SA. U. plantaginea plants with 3 - 4 tillers and 4 - 6 leaves were harvest at 3, 6, 9 and 12 days after application (DAT) of low rates of glyphosate. Samples were dried, extracted, analyzed by HPLC and LC-MS/MS. The maximum SA concentrations were observed at 6 days after glyphosate at 36 g.a.e.ha-1 was applied in plants of U. plantaginea with 4 to 6 leaves. The capability of this annual gramineae to produce elevated SA levels throughout the entire biomass affords its potential for a greater yield on a per hectare basis.

RESUMO: O interesse pelo ácido chiquímico (SA) tem apresentado um forte incremento nos últimos anos devido à crescente demanda da indústria farmacêutica e cosmética. O SA é utilizado como um precursor para a síntese do fosfato de oseltamivir (Tamiflu®), um potente inibidor viral. Este ácido é extraído principalmente da planta Illicium verum Hook. A disponibilidade desta planta é um fator limitante para o crescimento do mercado no futuro próximo. Este artigo propõe Urochloa plantaginea (Link.) webster tratada com sub doses de glifosato, como uma fonte alternativa de SA. Plantas de U. plantaginea com 3 - 4 perfilhos e 4 a 6 folhas foram tratadas com subdoses de glifosato e coletadas aos 0, 3, 6, 9 e 12 dias após sua aplicação (DAT). As amostras foram secas, extraídas e analisadas por HPLC e confirmadas por LC-MS/MS. As concentrações máximas de SA foram observadas aos seis dias após aplicação do glifosato a 36 g.e.a.ha-1 em plantas de U. plantaginea com 4 - 6 folhas. A capacidade anual dessa gramínea para produzir níveis elevados de SA em toda a biomassa, pode ser uma fonte economicamente viável de SA.

Pharmacoeconomic Evaluation of Peramivir versus Oseltamivir in the Treatment of Influenza Complicated with Febrile Seizures for Children / 中国药房

ABSTRACT OBJECTIVE：To compare the effectiveness and economics of peramivir and oseltamivir in the treatment of influenza complicated with febrile seizures in children. METHODS：In retrospective study，152 children with influenza complicated with febrile seizures were collected from our hospital during Dec. 2018 to Mar. 2019.They were divided into peramivir group（81 cases） and oseltamivir group （71 cases）. Fever remission time， medication duration， hospital duration， clinical efficacy （determined by convulsion，cough，nasal obstruction，runny nose，sore throat，etc.），the incidence of rash，the number of children with combined antibiotic and TCM were compared between 2 groups. Cost-effectiveness analysis was used to evaluate cost-effectiveness ratio（CER）and incremental cost-effectiveness ratio（ICER）of medication regimen in 2 groups. The sensitivity analysis of the effect and total cost were carried out with Logistic regression and multiple linear regression respectively through CER and ICER calculated by reducing 15％ drug price. RESULTS：There was no statistical significance in fever remission time， medication duration，hospitalization duration，the incidence of rash and proportion of children with combined antibiotics between 2 groups（P＞0.05）. There was statistical significance in proportion of children with combined TCM and clinical effect，and the proportion of children with combined TCM in peramivir group was significantly lower than oseltamivir group（P＜0.001）. Clinical effect of peramivir group was significantly better than that of oseltamivir group（P＝0.021）. Total cost of peramivir group and oseltamivir group were 5 442.84 yuan/person and 5 571.71 yuan/person（P＝0.795）；CER of them were 54.47 and 56.51；ICER of peramivir group was － 89.38. The results of sensitivity analysis were consistent with those of basic analysis.CONCLUSIONS： Compared with oseltamivir，peramivir is more effective and less costly for children with influenza and febrile seizures.

Assessing the susceptibility of highly pathogenic avian influenza H5N1 viruses to oseltamivir using embryonated chicken eggs

Background & objectives: The susceptibility of influenza viruses to neuraminidase inhibitors (NAIs) is studied using enzyme-based assays, sequence analysis and in vitro and in vivo studies. Oseltamivir carboxylate (OC) is the active prodrug of the NAI oseltamivir. There is lack of information on the use of embryonated chicken eggs for studying susceptibility of highly pathogenic avian influenza (HPAI) H5N1 viruses to antiviral drugs. The aim of the present study was to assess the use of 10 day old embryonated chicken eggs for studying antiviral susceptibility of HPAI H5N1 viruses. Methods: Two HPAI H5N1 viruses isolated from India were used in the study. Fluorescence-based NAI assay was performed to determine antiviral susceptibility of these viruses. In ovo antiviral assays were carried out using 10 day old embryonated chicken eggs. The virus dilutions were incubated with 14 ?g/ml of OC and inoculated in the allantoic cavity. In the eggs, 50 per cent egg infectious dose (EID50) titres as well as mortality were quantitated. Results: The two viruses used were susceptible to OC in the NAI assay. It was found that there was a significant drop in EID50titres; however, no significant protection from mortality after OC treatment was observed. Interpretation & conclusions: By measuring viral titres, the egg model was suitable to study the susceptibility of HPAI viruses to antiviral drugs along with NAI assay. The present study highlights the use of eggs as a model to study susceptibility of HPAI viruses to OC.

Pediatric viral orbital cellulites secondary to H1N1 infection: A case report

A 10-year-old boy admitted for high-grade fever and pneumonia developed left preseptal and early orbital cellulitis, unresponsive to higher intravenous antibiotics. He received oseltamivir, on testing positive for H1N1 virus on the nasopharyngeal and throat swabs. There was dramatic improvement with resolution of orbital cellulitis within 24 h of starting oseltamivir. We report a very rare presentation of pediatric orbital cellulitis secondary to systemic H1N1 infection. Prompt investigations and timely treatment with oseltamivir aided in complete resolution, avoiding vision and life-threatening complications.

Trends of human influenza infection in Chhattisgarh: a retrospective observational study

Background: Human influenza virus was recognized as a pandemic in 2009 by the World Health Organization (WHO). Since then many newer incidences was recognized in India, but there was no sufficient data from all state of India. This study will provide data from the Chhattisgarh state of India.Methods: It was a retrospective observational study from December 2015 to November 2017. All patient samples with suspected influenza infection were collected and analysed by Real-time reverse polymerase chain reaction (RT-PCR).Results: 341 patients’ sample was collected and analysed; among these samples, 07.9% of patients have all three serotype of influenza positive. Raipur district has the highest incidence of influenza A followed by Durg and Raigarh district of Chhattisgarh. There was no significant difference between male and female who was affected by the influenza virus.Conclusions: The incidence of Human influenza virus is lesser in Chhattisgarh as compare to the average states of India and the state capital has a higher rate of sample collection as well as positive influenza infection.

Antiviral Drugs For Influenza Viruses

Antiviral drugs have significant action against influenza viruses A and B. Virus spread deadly disease in which many people die, and the country economy greatly suffer. Presently, most of the people need to get vaccination, which is depending on the dose limit in humans. It reacts directly or sometimes indirectly in the form of metabolites. However, it is mandatory to know how much drug is absorbed or metabolites concentration after administered. Therefore, pharmacokinetics data is very crucial for all drugs. Our review discusses the mechanism of drugs action and their activity and also describes how antiviral drugs and their metabolites is determined using a highly sensitive instrument such as high-performance liquid chromatography (HPLC), ultra-pressure liquid chromatography (UPLC), mass spectrometry (MS). Therefore, the present review gives brief information about antiviral drugs, their activity, biotransformation and analytical methods for quantification and this information will be helpful for any future studies done by experts in this field and will be beneficial for research scientists and influenza experts of all over the globe.

Controversia sobre oseltamivir y su efectividad contra influenza / Controversy over oseltamivir and its effectiveness against influenza

Las complicaciones de las infecciones respiratorias virales ocasionan mortalidad importante. Durante la epidemia de influenza H1N1 del 2009 se reportaron 18449 fallecimientos en todo el mundo. En Perú fueron 312 los fallecimientos por gripe H1N1 reportados por el Ministerio de Salud. El oseltamivir se sigue considerando esencial en los casos severos de influenza H1N1; sin embargo, existe controversia sobre su beneficio y su seguridad. Se revisa la literatura, la cual nos lleva a concluir que es importante el uso racional y la evaluación de su costo efectividad.

Complications of viral respiratory infections cause significant mortality. During the 2009 H1N1 flu epidemic, 18449 deaths were reported worldwide. In Peru, there were 312 deaths due to H1N1 flu reported by the Ministry of Health. Oseltamivir is still considered essential in severe cases of H1N1 influenza; however there is controversy about their benefit and their safety. The literature is reviewed, which leads us to conclude that rational use and the evaluation of its cost effectiveness are important.

Reducing Mortality & Hospital Stay In Swine Flu Patients With Early Diagnosis And Treatment With Oseltamivir And Iv Vitamin C- A Detailed Clinical Perspective.

–H1N1 INFECTION also known as Swine flu, is a viral illness seen in Humans. 2009 WHO declared a Pandemic as many people suffered worldwide. The clinical picture in severe cases of pandemic (H1N1) 2009 influenza is markedly different from the disease pattern seen during epidemics of seasonal influenza. [1] The dominant strain flu strain in India this year was the A/Michigan/7/2009 (H1N1) pdm09 virus, which replaced in 2016. A/California/7/2009 (H1N1) pdm09 virus as the predominant virus around the world. As per ICMR reports, A cross–sectional study on patients coming with flu like symptoms was carried out over a period of 12 months in a public hospital. Total 300 Patients were tested, 71 cases were admitted.43 were positive for H1N1. The Patients were categorised them into A, B, C as per National guidelines of WHO on H1N1 epidemics, they were divided in 2 Random groups. Group 1 was treated with Oseltamivir 75 mg Bid and Vitamin C 1500 mg IV/day. A reduced rate of complications of PCR POSITIVE H1N1 Michigan/7/2009/pdm09 H1N1, was observed. The average hospital stays remained 4 days as compared to 10 days in patients not given Vitamin C iv. No death was reported after discharge. Early administration of Vitamin C administration as adjuvant therapy with Oseltamivir, helped to reduce hospital stay, complications and Mortality

Influenza A. Manejo ambulatorio / Influenza A. Ambulatory management

Introducción. La influenza A constituye uno de los principales problemas de salud que enfrenta la humanidad.El manejo clínico ambulatorio usando el protocolo de oseltamivir y saturomería permite realizar una práctica evaluación. Objetivo. Evaluar resultados usando protocolo de oseltamivir y saturometría en atención médica ambulatoria y emergencias en pacientes con influenza A. Métodos. Realizar un estudio clínico experimental aleatorio en pacientes con influenza A, usando protocolo con oseltamivir y saturometría y compararlo con tratamiento estándar. Conclusiones. La influenza A seguirá afectandónos por varios años más, debemos asumir una capacidad de respuesta, que incluya: la detección y confirmación de casos; así como su manejo clínico oportuno y eficaz. (AU)

Introduction. Influenza A is one of the main health problems facing humanity. Outpatient clinical management using the oseltamivir and saturomer protocol allows a practical evaluation. Objective. To evaluate results using oseltamivir protocol and saturometry in ambulatory medical care and emergencies in patients with influenza A. Methods. Perform a randomized experimental clinical study in patients with influenza A, using procolo with oseltamivir and saturometry and compare it with standard treatment. Conclusions. Influenza A will continue to affect us for several more years, we must assume a capacity to respond, that include: the detection and confirmation of cases; as well as its timely and effective clinical management. (AU)

Oseltamivir induced sinus bradycardia: an area of potential concern

Oseltamivir was approved for the prevention and treatment of influenza in 1999 by the USFDA (US Food and Drug Administration). The use of Oseltamivir is increasing rapidly all over the world, especially after the 2009 “Swine Flu” pandemic. Less data is published as far as the cardiovascular side effects of Oseltamivir are concerned, but it could be associated with some serious cardiovascular side effects. This study presented a case series of 5 cases suspected to be suffering from seasonal influenza H1N1 (“Swine Flu”), who developed sinus bradycardia while they were on Oseltamivir therapy.

Psychiatric Symptoms after Taking Oseltamivir in a Child and Its Causality Assessment

Oseltamivir is an antiviral medication prescribed to prevent and treat influenza A and B. A case from a community pharmacy in Korea was reported for an adverse event associated with oseltamivir administration. A 20-month-old boy had psychiatric symptoms after receiving 2 doses of oseltamivir. Therefore, an evaluation of whether the psychiatric symptoms were caused by oseltamivir was required. To determine whether the adverse event resulted from the administrated medication or other factors, three tools were used: the Naranjo scale, the Korean causality assessment algorithm (Ver.2), and the World Health Organization-Uppsala Monitoring Center (WHO-UMC) criteria. The psychiatric symptoms occurred after oseltamivir administration, and were attenuated after oseltamivir termination. A possible cause of the psychiatric symptoms is high fever, but information on the body temperature of the patient was not sufficient. Therefore, it was unclear whether there were other nonpharmacological causes of adverse drug reaction. For these reasons, in terms of causality, the results evaluated by the three tools represented, “possible”, “probable”, and “probable/likely”, respectively.

Infuenza and Patients with Chronic Diseases and Elderly

@#Influenza is a highly contagious viral illness characterized by fever, cough, headache and myalgia. The influenza virus is a segmented ribonucleic acid (RNA) virus that can infect both humans and animals, and the capacity for reassortment when multiple viruses infect the same cell has led – and will continue to lead – to the development of novel pandemic influenza A viruses. The disease is generally self-limiting, although complications and deaths can occur, particularly in children < two years of age, adults >65 years of age, pregnant women, and immunosuppressed individuals. Specific antiviral therapy is available, including oseltamivir in Singapore, and is recommended for severe disease as well as those with higher likelihood for developing complications from influenza. In addition to hand hygiene and respiratory etiquette, antiviral prophylaxis may reduce the impact and burden of influenza in household and institutional settings. However, the primary means for preventing influenza is via annual vaccination in those above the age of two years. The influenza vaccine, while having variable efficacy depending on antigenic matching with circulating viruses each year, is safe and cost-effective at the population level.

A randomized controlled study of peramivir, oseltamivir and placebo in patients with mild influenza / 中华内科杂志

Objectives To evaluate the effectiveness and safety of peramivir trihydrate in patients with influenza.Methods This was a randomized,double-blind,double-dummy,placebo and positive control,multicenter clinical trial,comparing peramivir trihydrate with oseltamivir and placebo.The inclusive criteria were 15-70 years old,onset within 48 h,positive rapid influenza antigen test,and febrile(＞38℃) accompanied with at least two associated symptoms.The severe cases complicated with chronic pulmonary and cardiac diseases,malignancies,organ transplantation,hemodialysis,uncontrolled diabetes,immunocompromised status,pregnancy and coexistence of bacterium infections were excluded.All patients were randomized 2:2:1 to receive peramivir,oseltamivir and placebo respectively.The primary endpoint was the disease duration,the secondary endpoints included time to normal axillary temperature and normal living activities,viral response,and adverse effects.Results Following informed consent,133 patients were included in this study.Four patients were exclude due to missing medical records,not fitting inclusion or exclusion criteria and poor compliance.A total of 129 patients were finally analyzed,including 49 cases,54 cases and 26 cases in peramivir group,oseltamivir group and placebo group.The median disease duration were 96 (76,120)hours,105(90,124) hours,and 124 (104,172)hours in three groups respectively(P＞0.05).The time to normal axillary temperature,normal living activities and viral response were not significantly different in three groups(P＞0.05).Conclusion The value of antiviral therapy in patients with mild influenza needs to be further determined.

The curative effect of oseltamivir combined with Lingjiaowuhutang in 120 children with influenza / 中国医师进修杂志

Objective To observe the curative effect of oseltamivir combined with Lingjiaowuhutang in children with influenza. Methods One hundred and twenty cases of children with influenza were selected from November 2017 to December 2017 and they were divided into two groups, each with 60 cases. The patients in western medicine group were treated with oseltamivir alone , those in Chinese traditional medicine combined with western medicine group were treated with oseltamivir and Lingjiaowuhutang. The efficacy and duration of fever and cough were was compared between two groups. Results Thirty-three patients were confirmed influenza A and 87 patients were confirmed influenza B. The total effective rate in Chinese traditional medicine combined with western medicine group was significantly higher than that in western medicine group: 96.7% (58/60) vs. 86.7%(52/60), χ2= 3.927, P < 0.05. The duration of fever and cough in Chinese traditional medicine combined with western medicine group was significantly shorter than those in western medicine group: (30.18 ± 6.22) h vs. (36.24 ± 13.46) h, (120.18 ± 21.45) h vs. (143.14 ± 33.26) h, P < 0.05. Conclusions Oseltamivir combined with Lingjiaowuhutang in children with influenza has better efficacy and can shorten duration of disease. It is worthy of clinical application.

Uso racional de oseltamivir: Eficacia e impacto junto a la evidencia actual

En el año 2016, al igual que en el resto del Cono Sur, se observó en Uruguay un incremento en la epidemia de influenza A, lo que generó un aumento en la demanda asistencial y la necesidad de actualizar las recomendaciones sobre prevención y tratamiento de la infección por el virus influenza. En este artículo, el Comité de Farmacología y Terapéutica de la Sociedad Uruguaya de Pediatría realiza una breve actualización de la información disponible con relación al oseltamivir, cuya accesibilidad hay que garantizar y asegurar, promoviendo un uso racional, siendo un medicamento con beneficios escasos, riesgos conocidos y disponibilidad acotada. Se trata de un aporte más al fortalecimiento de la promoción del uso racional de medicamentos en niños y adolescentes.

During the year 2016, as in other countries of the Southern Cone, an advance in the influenza A epidemic was observed in Uruguay, leading to an increase on the demand of medical care and the need to update medical recommendations on prevention and treatment of influenza infection. In this article, the Committee of Pharmacology and Therapeutics of the Uruguayan Pediatrics Society makes a brief update of the information available related to oseltamivir, which accessibility has to be guaranteed, promoting its rational use, due to its scarce benefits, known risks and limited availability. This is a further contribution to strengthening the promotion of the rational use of medicines in children and adolescents.