Enteric absorption and pharmacokinetics of oseltamivir in critically ill patients with pandemic (H1N1) influenza

Ariano, Robert E.; Sitar, Daniel S.; Zelenitsky, Sheryl; Zarychanski, Ryan; Pisipati, Amarnath; Ahern, Stéphane P.; Kanji, Salmaan; Rello, Jordi; Kumar, Anand

doi:10.1503/cmaj.092127

Cited by 105 publications

(96 citation statements)

References 16 publications

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“…Immediate initiation of oseltamivir treatment potentially reduces the risk of complications and requirement for ICU admission,14 and we observed no difference in time from diagnosis to initiation of antiviral therapy between the second and third wave. In the critically ill patients with pandemic influenza, it has been suggested to increase the dose of oseltamivir to 300 mg daily,15, 16 but this is not supported by clinical data and the pharmacokinetics of oseltamivir 75 mg twice daily in intensive care patients have been demonstrated to be comparable to patients with mild disease 17. The majority of our patients were treated with 150 mg daily.…”

Section: Discussionmentioning

confidence: 78%

The first, second and third wave of pandemic influenza A (H1N1)pdm09 in North Denmark Region 2009–2011: a population‐based study of hospitalizations

Ørsted

Mølvadgaard

Nielsen

et al. 2013

Influenza Resp Viruses

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Background and objectivesDenmark experienced three waves of the new pandemic influenza A (H1N1)pdm09 from July 2009 to February 2011. The aim of the study was to describe the epidemiology and clinical characteristics of hospitalized patients in a defined population of North Denmark Region with a mixed urban and rural community of 579 000 inhabitants.MethodsReview of medical records of all hospitalized patients with confirmed influenza A from July 2009 to February 2011.ResultsTwo hundred and seventy‐three patients were admitted to hospital. The age‐related population incidences of hospitalization were as follows: 0–14 years: 111/100 000, 15–64 years: 39/100 000, and ≥65 years: 17/100 000. During the first wave (July 2009–August 2009), three patients were admitted – none received treatment in intensive care units (ICUs), during the second wave (October 2009–January 2010), 158 patients were admitted – nine received treatment in ICUs, and during the third wave (December 2010–February 2011), 112 patients were admitted – 25 received treatment in ICUs. Fourteen patients (5%) died within 30 days of diagnosis (median 55 years; range 14–76 years) and additional seven patients (2·6%) died within 365 days (median 25 years; range 1–86 years).ConclusionsPatients hospitalized with pandemic influenza A (H1N1)pdm09 were predominantly children and younger adults, and only a few patients were >65 years. The third wave was the most severe taking the number and percentage of patients admitted to ICUs and 30‐day mortality into consideration. We observed that the incidence of hospitalizations as well as clinical severity among younger adults did not decline from the second to the third wave.

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Section: Discussionmentioning

confidence: 78%

The first, second and third wave of pandemic influenza A (H1N1)pdm09 in North Denmark Region 2009–2011: a population‐based study of hospitalizations

Ørsted

Mølvadgaard

Nielsen

et al. 2013

Influenza Resp Viruses

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“…In selected cases, generally in immunocompromised patients or patients with previous exposure to oseltamivir, there is a higher risk for antiviral resistance; in case of refractory influenza A infection which persists despite neuraminidase inhibitors treatment, a study to assess virus resistance for oseltamivir should be performed and zanamivir should be initiated. It was observed that ICU patient might need an adjustment of the dose of antibiotic because of a different pharmacokinetic and pharmacodynamics; despite that, it seems not to be the case when enteral oseltamivir treatment is initiated [20]; in a study performed in ICU patients with pH1N1 infection, enteral absorption and plasmatic levels of Oseltamivir were therapeutic when a dose of 75 mg twice daily was delivered [21].…”

mentioning

confidence: 99%

Severe viral pneumonia in adults: what is important for the ICU physician?

Gattarello

Rello

2017

Hospital Practice

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“…In this study, no correlation was found between high concentration and clinical outcomes. Assuming that the drug reaches to the infected lung tissue well, it has been reported that standard doses are sufficient, no higher doses are needed and dose adjustment is necessary in patients with renal dysfunction requiring dialysis (47,48).…”

Section: Oseltamivir and Its Use In Intensive Care Unitmentioning

confidence: 99%

“…It has been emphasized that obesity is a significant risk especially in patients admitted to intensive care unit (11). In a study related with the pharmacokinetics of oseltamivir used in obese patients, it was concluded that dose adjustment was not necessary (48).…”

Section: Oseltamivir and Its Use In Intensive Care Unitmentioning

confidence: 99%

Influenza and the use of oseltamivir in children

2016

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Influenza is an infectious disease which causes significant morbidity and mortality. In the USA, approximately 200 000 hospital admissions and 36 000 deaths occur annualy due to severe influenza infections. Although influenza often causes a simple respiratory infection, it sometimes causes disorders affecting several organs including the lung, heart, brain, liver and muscles or serious life-threatening primary viral or secondary bacterial pneumonia. Currently, oseltamivir is the most important and effective drug for severe influenza infections. Severe influenza infections can be controlled and related deaths may be prevented with initiation of this drug especially within first 2 days. Oseltamivir is usually well tolerated and its most commonly reported side effect is related with the gastrointestinal system. In conclusion, the course of influenza changes in a positive direction and the rates of complications and mortality significantly reduce in patients in whom oseltamivir treatment is initiated as soon as possible. (Turk Pediatri Ars 2016; 51: 63-71)

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Enteric absorption and pharmacokinetics of oseltamivir in critically ill patients with pandemic (H1N1) influenza

Cited by 105 publications

References 16 publications

The first, second and third wave of pandemic influenza A (H1N1)pdm09 in North Denmark Region 2009–2011: a population‐based study of hospitalizations

The first, second and third wave of pandemic influenza A (H1N1)pdm09 in North Denmark Region 2009–2011: a population‐based study of hospitalizations

Severe viral pneumonia in adults: what is important for the ICU physician?

Influenza and the use of oseltamivir in children

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