Who should receive Tamiflu for swine flu?

ANTIBACDUS-PAN: Antibacterial Utilization among Adult Patients Before and During COVID-19 Pandemic within 12-Months Period: A Tertiary Hospital Pharmacoepidemiology Study

Objective

Irrational use of antibacterials is a concern during the COVID-19 pandemic. Hospital pharmacoepidemiology studies are important for evaluating the rational use of medicines, especially antibacterials, during pandemics. Defined daily doses (DDD) and drug utilization 90% (DU90%) are established methods for the evaluation of drug utilization. We aimed to evaluate antibacterial utilization in a tertiary hospital setting at Koç University Hospital (KUH).

Materials and Methods

This cross-sectional, descriptive study was retrospectively conducted with data extracted from KUH Inpatient Electronic Order System (CP) and was carried out for a period of one year. Antibacterial utilization of adult (aged ≥ 18 years) inpatients, who were prescribed at least one type of systemic antibacterial (ATC code J01), was evaluated using the recommended parameter DDD/100 admission and compared between 6 months before COVID-19 and during COVID-19 periods. March 11, 2020, the very first COVID-19 diagnosed case in Turkey, was set as the cutoff date of the 6-month period for the selection of the compared antibacterials using the DU90% method.

Results

Finally, 3280 of 5942 and 2605 of 4942 prescriptions for pre-COVID-19 and COVID-19 periods were included, respectively. Antibacterial utilization according to DDD/100 admissions increased from 193.96 to 201.26 DDD/100 admissions after the initiation of COVID-19 pandemic. The most utilized antibacterials were piperacillin and enzyme inhibitors in pre-COVID-19 period, whereas meropenem was utilized the most during COVID-19 period. Azithromycin utilization increased by 656.24%, whereas clarithromycin utilization decreased by 52.12%. Antibacterials were utilized most in general surgery department, with an increase of 17.57%.

Conclusion

There is an increase in antibacterial utilization in KUH during COVID-19 pandemic, especially reserved antibacterials, which is a concern for antibacterial resistance.

Clinical profile of swine flu in children at Puducherry

OBJECTIVE

To study the clinical profile and outcome of children screened and diagnosed for Swine flu at a tertiary care hospital.

METHODS

All Children with suspicion of swine flu infection attending our hospital during the epidemic from August 2009 through January 2010 were screened and categorized into A, B and C as per guidelines of National Health and family welfare. Patients in Category A were advised home quarantine, Category B tested and treated with ostelamivir and Category C were hospitalized.

RESULTS

Among 424 cases screened for Swine flu, 79 were children in the age group 0-12 years of age (18.6%). The median age of presentation was 5 years. Children belonging to Category A were 43(54.4%), Category B were 31(39.2%) and Category C were 5(6.3%). Out of the cases that were screened, 19 children were confirmed positive for H1N1 infection(30.2%).Out of positive cases 8 were in category A (42%), eight were in category B (42%) and five were in category C (26.3%).

CONCLUSIONS

During the epidemic of swine flu at puducherry, majority of cases were category A with mild symptoms. Home quarantine and preventive measures during the epidemic were found to be far more important than testing and treating with Oseltamivir.

Swine-origin influenza A (H1N1) viral infection: radiographic and CT findings

OBJECTIVE

The objective of our study was to review the chest radiographic and CT findings in patients with swine-origin influenza A (H1N1) virus (S-OIV) infection.

CONCLUSION

The most common radiographic and CT findings in seven patients with S-OIV infection are unilateral or bilateral ground-glass opacities with or without associated focal or multifocal areas of consolidation. On MDCT, the ground-glass opacities and areas of consolidation had a predominant peribronchovascular and subpleural distribution, resembling organizing pneumonia.

The national pandemic flu service, oseltamivir, and a case of pancreatitis

The recent outbreak of the influenza virus H1N1 continues to pose a serious public health threat at a population wide level. In response to this, the UK National Health Service has made antiviral medication available to the general public in a unique way. Individuals can receive treatment without having to consult a medical practitioner, by simply answering a set of questions online or over the telephone. We present the case of a 65-year-old woman who developed a case of acute pancreatitis shortly after taking oseltamivir. Extensive investigation revealed that she had no risk factors or other identifiable cause for developing pancreatitis, and the possible adverse drug reaction has been reported to the Medicines and Healthcare Products Regulatory Agency. Concerns regarding the strategy to provide antiviral medication to the population using this novel approach are discussed in light of patient safety and implications for health policy.

Activity of Isatine-Sulfadimidine Derivatives against 2009 Pandemic H1N1 Influenza Virus in Cell Culture

Background:

The development of antiviral drugs has provided crucial new means to mitigate or relieve the debilitating effects of many viral pathogens. New classes of inhibitors are essential to combat swine influenza viral infection.

Methods:

A series of isatine-sulfadimidine derivatives were screened for antiviral activity against swine influenza A/California/07/2009 (H1N1) virus in Madin–Darby canine kidney (MDCK) cell culture. Cytotoxicity of the synthesized compounds was also tested in uninfected MDCK cells.

Results:

All the compounds inhibit the influenza A (H1N1) in MDCK cells. The most active compounds, SPIII-5Br and SPIII-5H, inhibited virus-induced cytopathology by 50% at 27 and 30 μM, respectively, with 50% cytotoxicity occurring at a much higher dose (975–1,000 μM). The positive control compound ribavirin inhibits the replication of the virus at 18 μM and cytotoxic concentration was found to be >1,000 μM.

Conclusions:

SPIII-5Br and SPIII-5H exhibited potency in the same range as ribavirin and are suitable candidate molecules for further investigation.

Swine origin influenza (swine flu)

Swine origin influenza was first recognized in the border area of Mexico and United States in April 2009 and during a short span of two months became the first pandemic. The currently circulating strain of swine origin influenza virus of the H1N1 strain has undergone triple reassortment and contains genes from the avian, swine and human viruses. It is transmitted by droplets or fomites. Incubation period is 2 to 7 days. Common clinical symptoms are indistinguishable by any viral respiratory illness, and include fever, cough, sore throat and myalgia. A feature seen more frequently with swine origin influenza is GI upset. Less than 10% of patients require hospitalization. Patients at risk of developing severe disease are - younger than five years, elderly, pregnant women, with chronic systemic illnesses, adolescents on aspirin. Of the severe manifestations of swine origin influenza, pneumonia and respiratory failure are the most common. Unusual symptoms reported are conjunctivitis, parotitis, hemophagocytic syndrome. Infants may present with fever and lethargy with no respiratory symptoms. Diagnosis is based on RT PCR, Viral culture or increasing neutralizing antibodies. Principle of treatment consist of isolation, universal precautions, good infection control practices, supportive care and use of antiviral drugs. Antiviral drugs effective against H1N1 virus include: oseltamivir and zamanavir. With good supportive care case fatality is less than 1%. Preventive measures include: social distancing, practicing respiratory etiquette, hand hygiene and use of chemoprohylaxis with antiviral drugs. Vaccine against H1N1 is not available at present, but will be available in near future.

Guidelines on management of human infection with the novel virus influenza A (H1N1)--a report from the Hospital das Clínicas of the University of São Paulo

The pandemic novel influenza A (H1N1) infection was considered widespread in Brazil on July, 2009. Since then, 9.249 cases were confirmed in Brazil, most of them concentrated in São Paulo. The Hospital das Clínicas of the University of São Paulo is a reference center for H1N1 cases in São Paulo. The purpose of this review is to analyze the evidence concerning diagnosis, prevention, and treatment of novel influenza A (H1N1) infection. In addition, we propose guidelines for the management of this pandemic emphasizing Hospital das Clínicas "bundles" for the control of the pandemic novel influenza A (H1N1).