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Original Research: CHEST INFECTIONS |

Timing of Oseltamivir Administration and Outcomes in Hospitalized Adults With Pandemic 2009 Influenza A(H1N1) Virus InfectionOseltamivir Timing and Outcome in Pandemic A(H1N1)

Diego Viasus, MD; José Ramón Paño-Pardo, MD, PhD; Jerónimo Pachón, MD, PhD; Melchor Riera, MD, PhD; Francisco López-Medrano, MD, PhD; Antoni Payeras, MD, PhD; M. Carmen Fariñas, MD, PhD; Asunción Moreno, MD, PhD; Jesús Rodríguez-Baño, MD, PhD; José Antonio Oteo, MD, PhD; Lucia Ortega, MD, PhD; Julián Torre-Cisneros, MD, PhD; Ferrán Segura, MD, PhD; Jordi Carratalà, MD, PhD,; for the Novel Infl uenza A(H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI)
Author and Funding Information

From the Departments of Infectious Diseases from the Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona (Drs Viasus and Carratalà), Barcelona; Hospital Universitario La Paz-IDIPAZ (Dr Paño-Pardo), Madrid; Hospital Universitario Virgen del Rocío (Dr Pachón), Sevilla; Hospital Universitario Son Dureta (Dr Riera), Palma de Mallorca; Hospital Universitario 12 de Octubre (Dr López-Medrano), Madrid; Hospital Son Llàtzer (Dr Payeras), Palma de Mallorca; Hospital Universitario Marqués de Valdecilla (Dr Fariñas), Santander; Hospital Universitario Clinic (Dr Moreno), Barcelona; Hospital Universitario Virgen Macarena (Dr Rodríguez-Baño), Sevilla; Hospital San Pedro-CIBIR (Dr Oteo), Logroño; SCIAS-Hospital de Barcelona (Dr Ortega), Barcelona; Hospital Universitario Reina Sofía-IMIBIC, University of Córdoba, (Dr Torre-Cisneros) Córdoba; and Hospital Parc Tauli (Dr Segura), Sabadell, Spain.

Correspondence to: Jordi Carratalà, MD, PhD, Department of Infectious Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, L’Hospitalet de Llobregat, Barcelona, Spain; e-mail: jcarratala@ub.edu


A list of the study group members is available in e-Appendix 1.

Funding/Support: This study was supported by Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, Programa de Investigación sobre gripe A/H1N1 (grant GR09/0014), and Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III. It was cofinanced by the European Regional Development Fund “A way to achieve Europe,” Spanish Network for Research in Infectious Diseases (REIPI RD06/0008). Dr Viasus is the recipient of a research grant from the Institut d´Investigació Biomèdica de Bellvitge (IDIBELL).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(4):1025-1032. doi:10.1378/chest.10-2792
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Background:  Data on the clinical effectiveness of oseltamivir in patients with pandemic 2009 influenza A(H1N1) (A[H1N1]) virus infection are scarce. We aimed to determine the effect of timing of oseltamivir administration on outcomes in hospitalized adults with A(H1N1).

Methods:  Observational analysis of a prospective cohort of adults hospitalized with laboratory-confirmed A(H1N1) was performed at 13 Spanish hospitals. Time from onset of symptoms to oseltamivir administration was the independent variable. Outcomes were duration of fever, hospital length of stay (LOS), need for mechanical ventilation, and mortality during hospitalization. Multivariate logistic regression was used to describe the association between the independent variable and the outcomes.

Results:  Five hundred thirty-eight hospitalized patients with A(H1N1) were studied. The median time from onset of symptoms to oseltamivir administration was 3 days (interquartile range [IQR], 2-5 days). With regard to outcomes, the median duration of fever was 2 days (IQR, 1-3 days), the median LOS was 5 days (IQR, 3-8 days), 49 patients (9.1%) underwent mechanical ventilation, and 11 patients (2%) died during hospitalization. In univariate analysis, prolonged duration of fever (above the median), prolonged LOS (above the median), need for mechanical ventilation, and mortality all increased with time to oseltamivir administration (χ2 test for trend P = .001, P ≤ .001, P = .008, and P = .001, respectively). After adjustment for confounding factors, time from onset of symptoms to oseltamivir administration (+ 1-day increase) was associated with a prolonged duration of fever (OR, 1.10; 95% CI, 1.02-1.19), prolonged LOS (OR, 1.07; 95% CI, 1.00-1.15), and higher mortality (OR, 1.20; 95% CI, 1.06-1.35).

Conclusions:  Timely oseltamivir administration has a beneficial effect on outcomes in hospitalized adults with A(H1N1), even in those who are admitted beyond 48 h after onset of symptoms.


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