Sunday, January 22, 2017

Triple therapy for influenza

PulmCrit - December 19, 2016 - By Josh Farkas 
"Antiviral therapy for influenza is a sore subject. Oseltamavir was initially felt to be a silver bullet. Unfortunately, it turned out that its efficacy was overblown by publication bias. Discordance between guidelines, practice, and evidence remains frustrating.
Regardless, flu seasons is upon us again. A recent paper in CHEST provides some tantalizing evidence about possible treatment. Will this pan out, or is it just another fairy tale?...
  • Although oseltamavir has anti-viral activity against influenza, its efficacy has been clinically disappointing.
  • Naproxen and clarithromycin both have anti-viral and immunomodulatory effects in vitro and in mouse studies. Animal studies suggest that NSAIDs work synergistically with neuraminidase-inhibitor therapy.
  • Hung 2016 performed a single-center open-label study evaluating the addition of a 2-day course of naproxen and clarithromycin to oseltamavir among inpatients with pneumonia due to H3N2 influenza. Combination therapy reduced mortality, transfer to step-down units, pneumonia severity, and viral replication.
  • Further evidence is needed. In the interim, a brief course of naproxen and clarithromycin may be considered for carefully selected patients (e.g., onset <72 hours before presentation, patients admitted to the hospital with lab-proven influenza pneumonia, adequate renal function)."