Avian influenza medical therapy

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For more information about seasonal human influenza virus that is not associated with animal exposure, see Influenza

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Neuraminidase inhibitors can reduce the duration of viral replication and improve survival among patients with avian influenza. In cases of suspected avian influenza, oseltamivir, zanamivir, or peramivir should be administered as soon possible, preferably within 48 hours of symptom onset.

Medical Therapy

• Preliminary evidence demonstrates that neuraminidase inhibitors can reduce the duration of viral replication and improve survival among patients with avian influenza. In cases of suspected avian influenza, one of the following 3 neuraminidase inhibitors should be administered as soon possible, preferably within 48 hours of symptom onset.

Antiviral Agents for the Treatment of Avian Influenza

Agent	Recommended Dose	Duration
Oseltamivir	75 mg PO once daily (Patients with severe disease may have diarrhea and may not absorb oseltamivir efficiently)	A minimum of 10 days
Zanamivir	10 mg inhaled twice daily (Preferred if patients has diarrhea and malabsorption)	A minimum 5 days
Peramivir	600 mg IV as a single dose (Preferred if patients has diarrhea and malabsorption)	1 day

• The use of corticosteroids is not recommended.

• Physicians may consider increasing either the recommended daily dose and/or the duration of treatment in cases of severe disease.

• The use of amantadine is not recommended as most H5N1 and H7N9 avian influenza viruses are resistant to it.
• Supportive care is also an important cornerstone of the care of patients with avian influenza. Considering the severity of the illness and the possible complications, patients may require fluid resuscitation, vasopressors, intubation and ventilation, paracentesis, hemodialysis or hemofiltration, and parentral nutrition.

• 1. Preferred regimen:Oseltamivir 75 mg PO qd for a minimum 10 days

• Note:Patients with severe disease may have diarrhea and may not absorb oseltamivir efficiently

• 2. Patients with Avian Influenza who have diarrhea and malabsorption

• Preferred regimen (1): Zanamivir 10 mg inhaled bid for minimum 5 days
• Preferred regimen (2): Peramivir 600 mg IV as a single dose for 1 day
• Note(1): Preliminary evidence demonstrates that Neuraminidase inhibitor can reduce the duration of viral replication and improve survival among patients with avian influenza. In cases of suspected avian influenza, one of the following 3 neuraminidase inhibitors should be administered as soon possible, preferably within 48 hours of symptom onset.
• Note(2): The use of Corticosteroids is not recommended.
• Note(3): Physicians may consider increasing either the recommended daily dose and/or the duration of treatment in cases of severe disease.
• Note(4): The use of Amantadine is not recommended as most H5N1 and H7N9 avian influenza viruses are resistant to it.
• Note(5): Supportive care is also an important cornerstone of the care of patients with avian influenza. Considering the severity of the illness and the possible complications, patients may require fluid resuscitation, vasopressors, intubation and ventilation, paracentesis, hemodialysis or hemofiltration, and parentral nutrition.