Which medications are used for the treatment of for avian (H5N1) influenza pneumonia?

Updated: Mar 24, 2021
  • Author: Zab Mosenifar, MD, FACP, FCCP; Chief Editor: John J Oppenheimer, MD  more...
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Avian H5N1 influenza should be treated with oseltamivir, even after the 48-hour window, because a reduction in mortality of hospitalized persons with seasonal influenza or avian influenza A (H5N1) virus infection was reported even when oseltamivir treatment was initiated later. The optimal duration and dose is not clear, but the WHO recommends consideration of higher dosage (eg, 150 mg PO bid) and longer duration in severe infections.

Avian H5N1 influenza has exhibited resistance to oseltamivir (clade 1 and subclade 2.1 with H274Y and N294S mutations). These resistant strains maintained susceptibility to zanamivir. Some viruses circulating in birds (subclade 2.3.4) demonstrated reduced susceptibility to zanamivir but sensitivity to the adamantanes (amantadine/rimantadine). Thus, for resistant strains (especially subclades 2.2 and 2.3.4), consideration for combination therapy with neuraminidase inhibitor-adamantane or oseltamivir-ribavirin, or even triple therapy with neuraminidase inhibitor-adamantane-ribavirin, should be given. [60]

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