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Effect of a Triple Combination of Oseltamivir, Ribavirin, and Amantadine in Patients With Severe 2009 H1N1 Influenza Pneumonia FREE TO VIEW

Yeo Chang Dong, MD; Rhee Chin Kook, MD; Yong Soo Kwon, MD; Kim Youngkyoon, MD; Lim Sung Chul, MD; Shin Hong Joon, MD; Kim Seok Chan, MD
Chest. 2011;140(4_MeetingAbstracts):760A. doi:10.1378/chest.1116923
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PURPOSE: Little information is available regarding the efficacy and safety of triple therapy consisting of oseltamivir, ribavirin, and amantadine for severe 2009 H1N1 influenza pneumonia. Our objective was to compare the safety and efficacy between oseltamivir monotherapy and triple therapy for severe 2009 H1N1 influenza pneumonia.

METHODS: We retrospectively reviewed the medical records of 33 patients with laboratory-confirmed severe 2009 H1N1 influenza pneumonia who were admitted to Seoul St. Mary’s Hospital and Chonnam National University Hospital (Korea) between September 2009 and February 2010.

RESULTS: For the 33 patients, the PaO2/FiO2 (PF) ratio was 155.94 ± 17.6 (mean ± SEM) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score was 16.25 ± 1.74. Mechanical ventilation was applied in 20 cases (60.6%), and the overall survival rate was 66.7%. Fifteen (45.5%) of the 33 patients were treated with oseltamivir monotherapy, and 18 (54.5%) received triple therapy (oseltamivir, ribavirin, and amantadine). Age, gender, baseline APACHE II score, and baseline PF ratio did not differ significantly between the two treatment groups. The survival rate was 66.7% in both the monotherapy (10/15) and triple therapy groups (12/18). There was also no significant difference in duration of hospital stay (19.47 ± 5.54 vs. 28.94 ± 9.19, mono vs. triple; P = 0.337) or intensive care unit stay (18.08 ± 6.67 vs. 21.40 ± 6.03; P = 0.420). The decrease in hemoglobin level was greater in the triple therapy group (10.83 ± 0.44 → 9.65 ± 0.51 g/dl) than in the monotherapy group (12.41 ± 0.54 → 11.82 ± 0.44 g/dl; P = 0.003).

CONCLUSIONS: Triple therapy was not superior to oseltamivir monotherapy in terms of treatment efficacy for severe 2009 H1N1 influenza pneumonia.

CLINICAL IMPLICATIONS: Further study concerning the efficacy of triple therapy for severe influenza pneumonia is needed.

DISCLOSURE: The following authors have nothing to disclose: Yeo Chang Dong, Rhee Chin Kook, Yong Soo Kwon, Kim Youngkyoon, Lim Sung Chul, Shin Hong Joon, Kim Seok Chan

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