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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？
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发表于 2014-2-19 09:10
发表于 2014-2-19 09:27
