Monday, March 13, 2006

Bird Flu Advice: Keep this somewhere

I was going to say keep these links for when the outbreak comes. But now I think it would be better to copy this text and PRINT it to paper. Why? because when people start dropping no one is going to care if your internet is working. Hell, forget the generators that power your house!

Print this.
From a few links starting from the World Health Organization regarding the Bird Flu. The text below is about recommended treatment at the onset. Read the whole thing from the beginning, (not given below). It gets scary when it talks about organ failure at about the 5th day.

http://www.who.int/csr/disease/avian_influenza/guidelinestopics/en/index1.html

http://content.nejm.org/cgi/content/full/353/13/1374

http://www.fda.gov/cder/news/relenza/default.htm


Antiviral Agents

Patients with suspected influenza A (H5N1) should promptly receive a neuraminidase inhibitor pending the results of diagnostic laboratory testing. The optimal dose and duration of treatment with neuraminidase inhibitors are uncertain, and currently approved regimens likely represent the minimum required. These viruses are susceptible in vitro to oseltamivir and zanamivir.46,47 Oral osel-tamivir46 and topical zanamivir are active in animal models of influenza A (H5N1).48,49 Recent murine studies indicate that as compared with an influenza A (H5N1) strain from 1997, the strain isolated in 2004 requires higher oseltamivir doses and more prolonged administration (eight days) to induce similar antiviral effects and survival rates.50 Inhaled zanamivir has not been studied in cases of influenza A (H5N1) in humans.

Early treatment will provide the greatest clinical benefit,15 although the use of therapy is reasonable when there is a likelihood of ongoing viral replication. Placebo-controlled clinical studies of oral oseltamivir51,52 and inhaled zanamivir53 comparing currently approved doses with doses that are twice as high found that the two doses had similar tolerability but no consistent difference in clinical or antiviral benefits in adults with uncomplicated human influenza. Although approved doses of oseltamivir (75 mg twice daily for five days in adults and weight-adjusted twice-daily doses for five days in children older than one year of age — twice-daily doses of 30 mg for those weighing 15 kg or less, 45 mg for those weighing more than 15 to 23 kg, 60 mg for those weighing more than 23 to 40 kg, and 75 mg for those weighing more than 40 kg) are reasonable for treating early, mild cases of influenza A (H5N1), higher doses (150 mg twice daily in adults) and treatment for 7 to 10 days are considerations in treating severe infections, but prospective studies are needed.

High-level antiviral resistance to oseltamivir results from the substitution of a single amino acid in N1 neuraminidase (His274Tyr). Such variants have been detected in up to 16 percent of children with human influenza A (H1N1) who have received oseltamivir.54 Not surprisingly, this resistant variant has been detected recently in several patients with influenza A (H5N1) who were treated with oseltamivir.21 Although less infectious in cell culture and in animals than susceptible parental virus,55 oseltamivir-resistant H1N1 variants are transmissible in ferrets.56 Such variants retain full susceptibility to zanamivir and partial susceptibility to the investigational neuraminidase inhibitor peramivir in vitro.57,58

In contrast to isolates from the 1997 outbreak, recent human influenza A (H5N1) isolates are highly resistant to the M2 inhibitors amantadine and rimantadine, and consequently, these drugs do not have a therapeutic role. Agents of clinical investigational interest for treatment include zanamivir, peramivir, long-acting topical neuraminidase inhibitors, ribavirin,59,60 and possibly, interferon alfa.61

Immunomodulators

Corticosteroids have been used frequently in treating patients with influenza A (H5N1), with uncertain effects. Among five patients given corticosteroids in 1997, two treated later in their course for the fibroproliferative phase of ARDS survived. In a randomized trial in Vietnam, all four patients given dexamethasone died. Interferon alfa possesses both antiviral and immunomodulatory activities, but appropriately controlled trials of immunomodulatory interventions are needed before routine use is recommended.

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