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avian flu
avian flu
<ref name=":1">Avian Influenza Factsheet. World Health Organization. http://www.who.int/mediacentre/factsheets/avian_influenza/en/ Accessed on April 22, 2015</ref>
<ref name=":1">Avian Influenza Factsheet. World Health Organization. http://www.who.int/mediacentre/factsheets/avian_influenza/en/ Accessed on April 22, 2015</ref>
*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.
:::*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.


:::*1.Preferred regimen:[[Oseltamivir]] 75 mg PO qd for a minimum 10 days  
::*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
:::*Note:Patients with severe disease may have diarrhea and may not absorb oseltamivir efficiently




:::*2.Patients has diarrhea and malabsorption
::*2.Patients has diarrhea and malabsorption
:::*Preferred regimen:[[Zanamivir]]10 mg inhaled bid for minimum 5 days {{or}} [[Peramivir]]600 mg IV as a single dose for1 day
:::*Preferred regimen:[[Zanamivir]]10 mg inhaled bid for minimum 5 days {{or}} [[Peramivir]]600 mg IV as a single dose for1 day
:::*Note(1): The use of [[corticosteroids]] is not recommended.
:::*Note(1): The use of [[corticosteroids]] is not recommended.

Revision as of 16:37, 7 July 2015

  • Influenza A and B
  • Adults
  • Preferred regimen:Oseltamivir (Tamiflu)75 mg bid for 5 days OR Zanamivir(Relenza) 10 mg (two 5-mg inhalations)bid for 5 days OR Peramivir(Rapivab) One 600 mg dose, via intravenous infusion for 15-30 minutes for 1 day
  • Children
  • Preferred regimen:Oseltamivir If younger than 1 yr old: 3 mg/kg/dose bid
  • If 1 yr or older, dose varies by child’s weight:
15 kg or less, the dose is 30 mg bid
 >15 to 23 kg, the dose is 45 mg bid ;
>23 to 40 kg, the dose is 60 mg bid;
 >40 kg, the dose is 75 mg bid  for 5 days OR
  • Zanamivir(Relenza) 10 mg (two 5-mg inhalations)bid
  • Note:FDA approved and recommended Peramivir(Rapivab) for use in adults ≥18 yrs
  • Dosing in Adult Patients with Renal Impairment
  • Oral oseltamivir
  • Creatinine clearance 61 to 90 mL/min-75 mg twice a day
  • Creatinine clearance 31 to 60 mL/min-30 mg twice a day
  • Creatinine clearance 10 to 30 mL/min-30 mg once daily
  • ESRD Patients on Hemodialysis
  • Creatinine clearance ≤10 mL/min-30 mg after every hemodialysis cycle. Treatment duration not to exceed 5 days
  • ESRD Patients on Continuous Ambulatory Peritoneal Dialysis-A single 30 mg dose administered immediately after a dialysis exchange


  • Intravenous Peramivir (single dose)
  • Creatinine clearance >50 mL/min-600mg
  • Creatinine clearance 30 to 49 mL/min-200mg
  • Creatinine clearance 10 to 29 mL/min-100mg
  • ESRD Patients on Hemodialysis-Dose administered after dialysis at a dose adjusted based on creatinine clearance




  • 2. Acanthamoeba Granulomatous Amebic Encephalitis and Disseminated Disease
  1. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.


  • Primary amoebic meningoencephalitis[1][2]
  • Preferred regimen: Amphotericin B 1.5 mg/kg /day bid for 3 days; then 1 mg/kg/day for 6 days AND1.5 mg/day intrathecal x 2 days; then 1 mg/day intrathecal qd for 8 days.
  • Note: Investigational drug called miltefosine also available for treatment.
  1. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  2. Template:Citeweb


avian flu [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.
  • 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 has diarrhea and malabsorption
  • Preferred regimen:Zanamivir10 mg inhaled bid for minimum 5 days OR Peramivir600 mg IV as a single dose for1 day
  • Note(1): The use of corticosteroids is not recommended.
  • Note(2): Physicians may consider increasing either the recommended daily dose and/or the duration of treatment in cases of severe disease.
  • Note(3):The use of amantadine is not recommended as most H5N1 and H7N9 avian influenza viruses are resistant to it.[2]
  • Note(4):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. Avian Influenza Factsheet. World Health Organization. http://www.who.int/mediacentre/factsheets/avian_influenza/en/ Accessed on April 22, 2015
  2. WHO guidelines for pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/ Accessed on April 22, 2015