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No advantage in double dose oseltamivir in treatment of severe influenza

23 Jul, 13 | by kuppell

A study investigating the validity of recommendations in treatment guidelines to use higher than approved doses of oseltamivir in patients with severe influenza has found that there were no virological or clinical advantages with double dose compared with standard dose.

The double-blind randomised control trial was conducted in 13 hospitals in Indonesia, Singapore, Thailand and Vietnam. The study included 326 patients, of which 246 were children (<15 years), and 165 and 161 patients were randomised to receive double (150mg twice daily or paediatric equivalent) or standard (75mg twice daily or paediatric equivalent) oseltamivir, respectively. A total of 260 patients (79.8%) were infected with influenza virus A, 53 (16.2%) with influenza virus B and 13 (3.9%) were found to be false positive by rapid antigen test.

The primary endpoint was the viral status according to reverse transcriptase PCR for influenza RNA in a combined nasal and throat swab on day 5 after oseltamivir treatment. Secondary clinical endpoints included mortality, mechanical ventilation, admission to intensive care, symptoms and resumption of activity. The researchers say: ‘We found that double dose oseltamivir was well tolerated but did not confer additional virological or clinical benefits over standard dose treatment in South East Asia. There were no differences between the treatment arms in detection of viral RNA or infectious virus on day 5.’ They do, however, point out that as all patients were randomised to an active treatment the study was not designed to evaluate the efficacy of oseltamivir in H5N1 infections. BMJ 2013;346:f3039.

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