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Double-dose oseltamivir no more effective in hospitalized patients

Clinical Question:
Is high-dose oseltamivir more effective than the standard dose in patients admitted to the hospital with confirmed severe influenza?

Bottom Line:
Doubling the dose of oseltamivir in hospitalized patients, which is recommended by some groups, is no more effective than the usual doses in children and adults at decreasing viral shedding, decreasing mortality, or reducing the need for care. This study did not answer the bigger question: Is oseltamivir more effective than placebo in patients with severe influenza? (LOE = 1b)

Reference:
South East Asia Infectious Disease Clinical Research Network. Effect of double dose oseltamivir on clinical and virological outcomes in children and adults admitted to hospital with severe influenza: double blind randomised controlled trial. BMJ 2013;346:f3039.  [PMID:23723457]

Study Design:
Randomized controlled trial (double-blinded)

Funding:
Government

Allocation:
Uncertain

Setting:
Inpatient (any location)

Synopsis:
The investigators conducting this study enrolled 326 patients admitted with confirmed severe influenza. A total of 75.5% of the patients were children between the ages of 1 year and 15 years, and 5.2% were infected with the H5N1 strain. The patients were randomized, concealed allocation unknown, to receive either standard dose or double dose oseltamivir for 5 days. Cure was defined as no detectable viral RNA on a nasal-and-throat sample on day 5 and cure rates were similar in the 2 groups (72.3% vs 68.2%). There was no difference when analyzed by virus type or subtype. Mortality was similarly high in the 2 groups (7.3% vs 5.6%). There was also no difference between the 2 groups in terms of days requiring oxygen therapy or mechanical ventilation or the need for intensive care. The larger question -- Is oseltamivir effective at all? -- was not addressed in this study. A recent meta-analysis found no benefit of oseltamivir treatment in outpatients (Family Pract 2013;30:125-133).

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