title: Comparison of High-Dose Versus Standard Dose Oseltamivir in Critically Ill Patients With Influenza.
abstract: BACKGROUND
  Limited data support high-dose oseltamivir in critically ill patients with influenza. In several recent influenza seasons, there were oseltamivir drug shortages.
  
  
  METHODS
  This was a retrospective cohort analysis of 57 patients admitted to the intensive care unit (ICU) with confirmed influenza. Patients receiving high-dose oseltamivir were compared to those receiving standard dosing.
  
  
  RESULTS
  When adjusted for clinically relevant predictors of disease severity, including age, duration of therapy, Acute Physiology and Chronic Health Evaluation II score, and receipt of extracorporeal membrane oxygenation, there was no difference in the duration of mechanical ventilation, oxygenation, ICU length of stay, or hospital length of stay between the high-dose and standard dose groups.
  
  
  CONCLUSIONS
  As compared to the standard doses of oseltamivir, higher-dose (ie, double dose) oseltamivir was not associated with improvement in any clinical outcomes. Using higher doses empirically on all patients during influenza season may exacerbate local drug shortages.
authors.affiliation: 1 Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA.
authors.forename: Zachary R
authors.initials: ZR
authors.lastname: Noel
authors.affiliation: 1 Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA.|2 Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA.
authors.forename: Melissa L Thompson
authors.initials: MLT
authors.lastname: Bastin
authors.affiliation: 3 Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Montgomery
authors.affiliation: 1 Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, KY, USA.|2 Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA.
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Flannery
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D016638:Critical Illness / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000188:drug therapy*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D053139:Oseltamivir / Q000008:administration & dosage*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir
keywords: critical care; dosage; influenza; intensive care; oseltamivir