Published Date: 2004-01-27 23:50:00
Subject: PRO> Avian influenza A (H5N1) virus, drug resistance (02)
Archive Number: 20040127.0316
AVIAN INFLUENZA A (H5N1) VIRUS, DRUG RESISTANCE (02)
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Date: Mon 26 Jan 2004
From: Richard I. Frankel <Richard.Frankel@med.va.gov>
With regard to treatment, while it is true that resistance to the
adamantanes may appear relatively quickly and thus make these drugs
relatively poor in terms of stopping epidemics, they have been proven
effective in treating individual patients and in controlling
outbreaks in institutions. In fact, there is no good evidence that
the neuraminidase inhibitors are any more effective. In the USA,
the adamantanes are less expensive than the neuraminidase inhibitors.
The side effects of amantadine, while real, may be lessened by
reducing the dose in high-risk patients, particularly the elderly and
those with impaired renal function. The same side effects may occur
with rimantadine, though they are less frequent.
In the USA, only oseltamivir is approved for prevention of disease,
and then only in those aged 13 years and older. For treatment,
oseltamivir is approved for those aged one year and older, and
zanamivir for those aged 7 years and older. Oseltamivir is the most
expensive of the 4 drugs in the USA.
I do not believe there are sufficient data to know how rapidly
resistance to the neuraminidase inhibitors will develop if they are
used widely during an epidemic.
In my opinion, antiviral drugs may be beneficial for individual
patients but are unlikely to play a major role in halting widespread
epidemics.
These opinions are my own and may not reflect the opinions of the
U.S. Department of Veterans Affairs.
--
Richard I. Frankel, MD, MPH, FACP
Associate Chief of Staff for Education
VA Pacific Islands Health Care System
459 Patterson Road, 11E
Honolulu, Hawaii 96819-1522
<Richard.Frankel@med.va.gov>
See Also
Avian influenza A (H5N1) virus, drug resistance 20040125.0298Avian influenza, human - East Asia (03) 20040126.0310
Avian influenza, human - East Asia (02) 20040126.0307
Avian influenza, human - East Asia 20040124.0283
Avian influenza A (H5N1) virus, human vaccine prospects 20040125.0300
Avian influenza, human - Thailand (02): confirmed 20040123.0262
Avian influenza, human - Thailand (03) 20040123.0268
Avian influenza, human - Thailand: suspected 20040122.0247
Avian influenza, human - Vietnam (02) 20040113.0138
Avian influenza, human - Vietnam (03) 20040114.0154
Avian influenza, human - Vietnam (04) 20040114.0155
Avian influenza, human - Viet Nam (05) 20040117.0181
Avian influenza, human - Vietnam (06) 20040118.0193
Avian influenza, human - Vietnam (07) 20040119.0213
Avian influenza, human - Vietnam (08) 20040119.0216
Avian influenza, human - Vietnam (09) 20040120.0225
Avian influenza, human - Vietnam (10) 20040122.0251
Avian influenza, human - Vietnam (11) 20040122.0258
Avian influenza, human - Vietnam: RFI 20040112.0127
Avian influenza, Taiwan - OIE 20040123.0273
Avian influenza, Thailand - OIE 20040124.0276
Avian influenza, WHO fact sheet 20040116.0171
Avian influenza - Eastern Asia 20040114.0145
Avian influenza - Eastern Asia (02) 20040116.0176
Avian influenza - Eastern Asia (04): RFI 20040119.0208
Avian influenza - Eastern Asia (05) 20040120.0222
Avian influenza - Japan (02) 20040112.0125
Avian influenza - Japan (03): OIE 20040114.0151
Avian influenza - Japan: RFI 20040111.0124
Avian influenza - Taiwan: not 20040114.0148
Avian influenza - Taiwan ex mainland China: susp. 20040101.0001
Avian influenza - Thailand (02): not 20040109.0097
Avian influenza - Thailand: RFI 20040105.0051
Avian influenza - Vietnam (02) 20040110.0106
Avian influenza - Vietnam: OIE 20040109.0101
..................cp/pg/jw
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