# 3776
The `standard’ adult course of Oseltamivir (Tamiflu) for seasonal flu has long been 2 - 75mg capsules per day, for 5 days.
Or a total of 10 pills.
And despite reports from the field in countries treating the H5N1 virus that 150mg/day wasn’t terribly effective (50+% mortality rate, even with treatment), the definition of a `treatment course’ hasn’t changed.
Doctors, of course, have had the latitude to make adjustments to these regimens – and so many bird flu patients in Vietnam, China, Indonesia, and Egypt have received more than the standard 10 pill course.
In March of 2007, it was announced that doctors in Hong Kong would begin clinical trials, looking to see if higher doses of antivirals improved patient survivability. See Hong Kong: Doctors To Test Higher Tamiflu Doses.
Shortly thereafter the WHO released the following guidance which allowed for two-fold higher dosage, and longer duration on a `case by case basis’:
Accordingly, many pandemic planners (particularly in the UK) began talking about the need for more Tamiflu in their stockpile. In November of 2007, I undertook a rather long discussion of the matter in How Much Tamiflu Is Enough?
Fast forward two years, and the pandemic we’ve got isn’t the pandemic we planned for.
The H1N1 swine flu virus, thankfully, doesn’t have the high CFR (Case Fatality Ratio) of it’s avian cousin. But for a small subset of patients, the viral pneumonia it can produce easily rivals bird flu in severity.
In Hong Kong, where the H5N1 Tamiflu clinical trial was supposed to take place, one hospital has been routinely doubling the dosage of Tamiflu for their most severely ill pandemic flu patients.
And so far, at least . . . not one of them has died.
Doctors at the Prince of Wales Hospital in Hong Kong are encouraged enough by these results to recommend doubling the dose of Tamiflu for all patients who are severely impacted by the pandemic flu.
This from the Hong Kong Standard.
City flu strategy may set roadmap for global fight
Mary Ann Benitez
Monday, September 28, 2009The treatment of severely ill swine flu (H1N1) patients at Prince of Wales Hospital - which has a zero death rate so far - may be held up as a model for the world.
The World Health Organization will consider new treatment guidelines at a meeting of experts in Washington next month, and the Hong Kong model is among those being discussed.
<SNIP>
It has treated at least 60 severely ill patients, out of the city's 106 severe cases, without loss of life, according to David Hui Sui-cheong, a specialist in respiratory medicine at Chinese University.
Hui said severely ill patients should receive double the dose of Tamiflu as viral pneumonia is what kills patients with pandemic H1N1.
Antibiotics are given to patients in intensive care units to treat underlying bacterial infections brought about by long use of ventilators, he added.
