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Oseltamivir and zanamivir are generally well-tolerated. Nausea and vomiting were reported with moderate frequency among adults receiving oseltamivir for treatment (nausea without vomiting, 10%; vomiting 9%). In children treated with oseltamivir, 14% reported vomiting. Oseltamivir suspension is formulated with sorbitol, which may be associated with diarrhea and abdominal pain in patients who are fructose-intolerant. Zanamivir is formulated for oral inhalation and is contraindicated in patients with asthma or chronic obstructive disease. As of December 18, 2009, 136 isolates (among more than ten thousand tested) of pandemic H1N1 were resistant to oseltamivir.62 Among the 32 cases for whom detailed information was available, 16 were associated with antiviral prophylaxis, and three had no history of exposure to oseltamivir. Resistance was associated with the common H275Y mutation with retention of zanamivir susceptibility.61 Antiviral therapy is most effective when started within 48 hours after the onset of symptoms; however, evidence suggests that treatment62 may benefit patients with prolonged or severe illness even when started more than 48 hours after the onset of illness. The recommended duration of treatment is 5 days. Hospitalized patients with severe infection might require longer antiviral courses. Some experts have advocated use of doubled doses of oseltamivir in critically ill patient despite lack of published date about efficacy. Zanavimir inhaled formulation is not designed to be used in any nebulizer or mechanical ventilator62,63 as there is a risk that the lactose drug carrier can obstruct ventilator equipment. For patients who are unable to take oral medication or in whom oral medication appears to be ineffective, peramavir, an investigational neuraminidase inhibitor formulated for intravenous administration, can be requested from the CDC under Food and Drug Administration (FDA) and emergency use authorization, although studies on efficacy and safety are limited.62,63
Symptomatic patients who have highly suspected or documented oseltamivir resistance should not be treated with peramivir because strains with the H275Y mutation have demonstrated reduced in vitro susceptibility to peramivir. These patients should be treated with intravenous zanamivir, which is an investigational drug that can be requested from FDA for compassionate use.62,63 The CDC suggests limiting the use of antiviral chemoprophylaxis to specific groups. Antiviral doses recommended for treatment and prophylaxis of 2009 H1N1 influenza in adult and children are listed in Table 8. Clinicians should consider empiric treatment with antibacterial drugs if bacterial co-infections is suspected during or after influenza. Antibiotic selection should take into consideration local data regarding frequency of pathogens causing secondary infection and the pattern of drug resistance. When pneumonia is present, treatment with antibiotics should follow evidence-based guidelines for community-acquired pneumonia.
In the spring of 2009, a novel influenza A (H1N1) virus emerged. It was detected first in the United States and spread quickly across the United States and the world. This new H1N1 virus contained a unique combination of influenza genes not previously identified in animals or people. This virus was designated as influenza A (H1N1)pdm09 virus. Ten years later work continues to better understand influenza, prevent disease, and prepare for the next pandemic.
The United States mounted a complex, multi-faceted and long-term response to the pandemic, summarized in The 2009 H1N1 Pandemic: Summary Highlights, April 2009-April 2010. On August 10, 2010, WHO declared an end to the global 2009 H1N1 influenza pandemic. However, (H1N1)pdm09 virus continues to circulate as a seasonal flu virus, and cause illness, hospitalization, and deaths worldwide every year.
Founded in 2009, The Rumpus is one of the longest running independent online literary and culture magazines