THE Department of Health recently reported the case of a patient who was severely ill with a new strain of A(H1N1) influenza (swine flu) and died despite being promptly treated with the antiviral drug oseltamivir, which is sold under the trade name Tamiflu.
The case will be investigated to determine if the patient died because the virus was resistant to the drug. One way or another, however, the patient’s death should serve as a reminder that Tamiflu is not a panacea.
On Aug. 21, the WHO issued guidelines for the use of antivirals in the treatment of patients infected with the A(H1N1) pandemic virus. The document stated that most patients infected with the virus experienced typical influenza symptoms and recovered fully within a week, even without medical treatment. That being the case, healthy patients who fall ill but do not suffer complications need not be treated with antiviral drugs.
For severely ill patients and those whose condition begins to deteriorate, the WHO recommends treatment with oseltamivir as soon as possible, preferably within 48 hours after serious symptoms appear.
Dangerous symptoms listed include shortness of breath or difficulty breathing, turning blue, bloody sputum, chest pain, high fever persisting beyond three days and low blood pressure.
Among A(H1N1) patients, treatment with oseltamivir can alleviate symptoms and speed up recovery, just as with seasonal influenza patients. While some experts consider it best to administer the medicine to all confirmed A(H1N1) patients within 48 hours, the WHO guidelines recommend that antivirals only be given if patients exhibit severe symptoms. This recommendation is probably based on concern that overuse of the drug will greatly increase the possibility of drug-resistant virus strains appearing.
The WHO’s Aug. 21 update on this year’s H1N1 pandemic says that the health body had been notified of 12 cases of oseltamivir-resistant strains worldwide. These were all isolated cases arising from mutations in the virus, and there were no apparent epidemiological links between them, nor is there any evidence of onward transmission from these cases.
Even so, several oseltamivir-resistant strains of seasonal H1N1 influenza have appeared over the past few years. Since none of the drug-resistant strains that have been isolated are highly infectious, they do not pose a significant risk to public health security. Since the new, pandemic influenza strain is an H1N1 variant, it would not be surprising if drug-resistant strains were to arise as a result of nonessential use of oseltamivir.
In Taiwan, regulations on the use of oseltamivir have been relaxed, making it likely that cases of resistance to the drug will occur. The danger is that a highly infectious, drug-resistant strain of the pandemic virus may appear and spread rapidly. In that case, it would be necessary to treat patients with the other known effective antiviral drug, zanamivir (trade name Relenza), instead.
Liou Pei-pai is a former director of the Taiwan Animal Health Research Institute.
TRANSLATED BY JULIAN CLEGG
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