Treatment options for 2009 H1N1 influenza: evaluation of the published evidence.
We evaluated the evidence regarding the effectiveness of various treatment strategies used for 2009 H1N1 influenza by reviewing available relevant studies. In total, 22 studies (15 cohort studies involving >10 patients, 5 cohort studies with < or = 10 patients and 2 case reports) were included. A total of 3020 patients [1068 (35.4%) critically ill, 1722 (57.0%) hospitalised and 230 (7.6%) outpatients, including 909 (30.1%) children] were involved. Notably, 487 (16.1%) were obese [body mass index (BMI) >30)], 362 (12.0%) had asthma or chronic obstructive pulmonary disease and 255 (8.4%) were pregnant. Antiviral treatment was administered to 1622 patients (53.7%), of whom 661 (40.8%) received oseltamivir monotherapy. Corticosteroids were administered in 323 (31.8%) of 1016 patients for whom relevant data were available. Similarly, 633 (85.0%) of 745 patients received antibiotics. Comparative data from the largest included study (involving 1088 patients) indicated that administration of antivirals within 2 days from symptom onset was significantly associated with reduced mortality (P<0.001). In summary, the scarcity of comparative available data hampered the establishment of any firm conclusions regarding the benefit that various treatment strategies may confer to patients with 2009 H1N1 influenza. Studies with a comparative design, as well as randomised studies are needed to clarify further this issue of major importance.
Falagas
Matthew E
ME
Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Athens, Greece. m.falagas@aibs.gr
Vouloumanou
Evridiki K
EK
Baskouta
Evagelia
E
Rafailidis
Petros I
PI
Polyzos
Kostantinos
K
Rello
Jordi
J
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000187:drug effects* / Q000302:isolation & purification*; D007251:Influenza, Human / Q000188:drug therapy* / Q000401:mortality / Q000821:virology*; D008297:Male; D008875:Middle Aged; D053139:Oseltamivir / Q000627:therapeutic use; D013997:Time Factors; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D053139:Oseltamivir