icchina 发表于 2014-2-19 09:10

对于重症H7N9病例，奥司他韦究竟要用多久？

近几月，接触了不少确诊或疑似H7N9流感肺炎病人，多为重症。抗病毒治疗，经常是一个大家关切，本人纠结的问题。我国2014年版的方案是这样叙述的：
（1）奥司他韦（Oseltamivir）：****剂量75mg每日2次，疗程5～7天，重症病例剂量可加倍，疗程可延长一倍以上。1岁及以上年龄的儿童患者应根据体重给药：体重不足15Kg者，予30mg每日2次；体重15～23Kg者，予45mg每日2次；体重不足23～40Kg者，予60mg每日2次；体重大于40Kg者，予75mg每日2次。对于吞咽胶囊有困难的儿童，可选用奥司他韦混悬液。重症者，剂量加倍，容易执行，****剂量即：150mg（2#） Bid，但是疗程可延长一倍以上，太难把握了。美国CDC指南，描述如下：
[*]The recommended treatment course for uncomplicated influenza is two doses per day of a neuraminidase inhibitor medication for 5 days; however, the optimal duration and dose are uncertain for severe or complicated influenza. Pending further data, longer courses of treatment (e.g., 10 days of treatment) should be considered for severely ill hospitalized H7N9 patients.

[*]Clinical judgment and virologic testing of lower respiratory tract specimens by rRT-PCR should guide decisions to consider treatment regimens longer than 5 days for patients with severe and prolonged illness, until clearance of viral shedding. For patients with lower respiratory tract disease, lower respiratory tract specimens, such as bronchoalveolar lavage or endotracheal aspirate, are preferred; an oropharyngeal (throat) swab may be collected if lower respiratory specimens are not available.
[*]Longer treatment regimens might be necessary in immunosuppressed persons who may have prolonged viral replication and also are at risk of developing antiviral-resistant virus.
[*]A higher dose of oseltamivir has been recommended by some experts (e.g., 150 mg twice daily in adults with normal renal function) for treatment of influenza in immunocompromised patients and in severely ill hospitalized patients, although it is unknown if this provides clinical benefit [38-40].

欢迎SIFIC论坛朋友，介绍您医院在H7N9感染防治中，奥司他韦使用方面，有什么经验或故事？

icchina 发表于 2014-2-19 09:23

曾经在邻省某三级医院会诊，被告知他们医院的一例H7N9流感肺炎确诊病人，不能把握何时停药，何时解除隔离。
尽管当时病情恢复良好，2次病毒PCR检测转为阴性，但是大家不敢停药，说是要请示卫生局领导。{:1_9:}














烟雨随风 发表于 2014-2-19 09:27

icchina 发表于 2014-2-19 09:23
曾经在邻省某三级医院会诊，被告知他们医院的一例H7N9流感肺炎确诊病人，不能把握何时停药，何时解除隔离。 ...

建议卫生局领导请教一下胡教授{:1_7:}

小飞0319 发表于 2014-2-19 09:32

路过，看到的，具体不是很清楚。

草原星空 发表于 2014-2-19 10:19

icchina 发表于 2014-2-19 09:23
曾经在邻省某三级医院会诊，被告知他们医院的一例H7N9流感肺炎确诊病人，不能把握何时停药，何时解除隔离。 ...

当专业被政治干预时，一切就显得那么滑稽{:1_2:}
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