|
|
INFLUENZA A (H1N1) - WORLDWIDE (65): ANTIVIRALS IN PREGNANCY, CORRECTION
************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Wed 17 Jun 2009
From: Nicholas Bennett <bennetni@upstate.edu>
Re: ProMED-mail Influenza A (H1N1) - worldwide (65): antivirals in
pregnancy 20090616.2224
----------------------------------------------------------------------
In the recent update of the safety of using Tamiflu during pregnancy,
I spotted an error. It was incorrectly stated that Tamiflu and
Relenza were oral and intranasal formulations of oseltamivir
respectively. In fact, Relenza is an inhaled (but not intranasal)
formulation of zanamivir -- an entirely different neuraminidase
inhibitor.
The distinction is important on 2 counts: Relenza is difficult to
administer to small children and to very sick patients who are
intubated, as it requires the patient inhale the drug. Also, the
2008-2009 seasonal H1N1 influenza (not the H1N1 swine-origin
influenza) has been nearly 100 percent resistant to oseltamivir in
the United States, but sensitive to zanamivir.
In the approaching winter season, this will pose issues with
treatment -- both empiric and targeted. H1N1 (human) will likely
require amantadine or zanamivir treatment, whereas H1N1 (swine
origin) will hopefully remain susceptible to oseltamivir, and
influenza B is inherently resistant to amantadine so will require
oseltamivir or zanamivir. H3N2 has been resistant to amantadine in
the recent past as well. The only common drug is zanamivir, so for
empiric treatment of young children or very sick patients,
combination therapy will likely be the only feasible approach. This
was the recommendation for the 2008-2009 season, but will have
ramifications for drug supply in the event of a widespread epidemic
with potentially limited vaccine control.
Rapid diagnostics will help with narrowing drug coverage but are not
available in many locations and even multiplex PCR can take several
days.
--
Nicholas Bennett MA(Cantab), PhD, MB/BChir
Fellow in Pediatric Infectious Disease
Department of Pediatrics
SUNY Upstate Medical University
750 East Adams Street
Syracuse 13210
USA
<bennetni@upstate.edu>
[ProMED-mail thanks Nicholas Bennett and also Stephen D Shafran
(University of Alberta) and others who have pointed out the error in
a Moderator's comment that Tamiflu and Relenza are proprietary
preparations of the same neuraminidase inhibitor oseltamivir. In fact
Tamiflu is the proprietary name for oseltamivir, as stated, but
Relenza is the proprietary name for a different neuraminidase
inhibitor called zanamivir. ProMED-mail regrets propagating this
error.
Nicholas Bennett has provided some useful additional information and
guidance regarding the use of these 2 neuraminidase inhibitors in
clinical practice. - Mod.CP]
[see also:
Influenza A (H1N1) - worldwide (65): antivirals in pregnancy 20090616.2224]
...................................cp/mj/lm
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Become a ProMED-mail Premium Subscriber at
<http://www.isid.org/ProMEDMail_Premium.shtml>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org
(NOT to an individual moderator). If you do not give your
full name and affiliation, it may not be posted. Send
commands to subscribe/unsubscribe, get archives, help,
etc. to: majordomo@promedmail.org. For assistance from a
human being send mail to: owner-promed@promedmail.org.
############################################################
############################################################
|