Use of Intravenous Peramivir for Treatment of Severe Influenza A(H1N1)pdm09

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Louie, Janice K. ; Yang, Samuel ; Yen, Cynthia ; Acosta, Meileen ; Schechter, Robert ; Uyeki, Timothy M.
• Description:
  Oral antiviral agents to treat influenza are challenging to administer in the intensive care unit (ICU). We describe 57 critically ill patients treated with the investigational intravenous neuraminidase inhibitor drug peramivir for influenza A (H1N1)pdm09 [pH1N1]. Most received late peramivir treatment following clinical deterioration in the ICU on enterically-administered oseltamivir therapy. The median age was 40 years (range 5 months-81 years). Common clinical complications included pneumonia or acute respiratory distress syndrome requiring mechanical ventilation (54; 95%), sepsis requiring vasopressor support (34/53; 64%), acute renal failure requiring hemodialysis (19/53; 36%) and secondary bacterial infection (14; 25%). Over half (29; 51%) died. When comparing the 57 peramivir-treated cases with 1627 critically ill cases who did not receive peramivir, peramivir recipients were more likely to be diagnosed with pneumonia/acute respiratory distress syndrome (p = 0.0002) or sepsis (p = <0.0001), require mechanical ventilation (p = <0.0001) or die (p = <0.0001). The high mortality could be due to the pre-existing clinical severity of cases prior to request for peramivir, but also raises questions about peramivir safety and effectiveness in hospitalized and critically ill patients. The use of peramivir merits further study in randomized controlled trials, or by use of methods such as propensity scoring and matching, to assess clinical effectiveness and safety.
• Subjects:
  Administration, Intravenous Adolescent Adult Aged Aged, 80 And Over Antiviral Agents Child Child, Preschool Critical Illness Cyclopentanes Female Guanidines Humans Infant Infant, Newborn Influenza, Human Influenza A Virus, H1N1 Subtype Male Middle Aged Pandemics Retrospective Studies Severity Of Illness Index Young Adult

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• Source:
  PLoS One. 2012; 7(6).
• Document Type:
  Journal Article
• Place as Subject:
  California
• Volume:
  7
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:c7b2372297924ef35238b946bfee9c0bc258f6b2e3f43c689d2259465273f55e
• Download URL:
  https://stacks.cdc.gov/view/cdc/10887/cdc_10887_DS1.pdf
• File Type:
  [PDF - 72.71 KB ]