# 3985
While the vast majority of H1N1 influenza victims recover quickly and without incident, a very small percentage go on to endure particularly serious and life-threatening symptoms – including ARDS (Acute Respiratory Distress Syndrome).
Last week, at the CHEST 2009 conference (Annual meeting of the American College of Chest Physicians), a study was presented on the results of an antiviral/steroid cocktail administered to ICU patients in Argentina during their recent pandemic wave.
This cocktail consisted of high dose oseltamivir (150mg twice a day), along with one of two steroids.
For those presenting with ARDS, they were given Methylprednisolone (Medrol) 1 mg/kg/day for 14 days. All other ICU patients received hydrocortisone 300 mg/day.
The administration of corticosteroids in ARDS has been tried in the past, with varying levels of success. The experience from SARS in 2003 and H5N1 in the middle of this decade showed short-term improvement, but long-term survival rates were less than encouraging.
In 2007 the WHO (World Health Organization) advised against the use of steroids in the treatment of Bird flu, stating:
Corticosteroid therapy has failed so far to show effectiveness, and prolonged or high dose corticosteroids can result in serious adverse events in H5N1 patients, including opportunistic infection. Corticosteroids should not be used routinely, except for persistent septic shock with suspected adrenal insufficiency.
But that was then. This is now.
I’ve excerpted some passages from a report on Doctor’s Guide that reviews the presentation at the CHEST 2009 Conference.
It is, admittedly, a small study. Only 13 patients. But the results are encouraging.
Follow the link to read it in its entirety.
By Betty S. Riggs
SAN DIEGO -- November 9, 2009 -- The combination of oseltamivir and prolonged corticosteroid therapy results in clinical improvement in patients with hypoxaemic respiratory failure and influenza A(H1N1), according to a study presented here at CHEST 2009, the annual meeting of the American College of Chest Physicians.
<SNIP>
By day 7 of treatment, patients had significant improvement in lung injury score (LIS) and multiple organ dysfunction syndrome as measured by the Sequential Organ Failure Assessment (SOFA) score. From day 1 to day 7, the LIS decreased from 2.83 +- 0.8 to 2.01 +- 0.5 (P = .003) in H1N1-positive patients and from 3.45 +- 0.3 to 2.15 +- 0.8 (P = .02) in H1N1-negative patients.
From day 1 to day 7, the SOFA score decreased from 5.9 +- 1.6 to 3.3 +- 2.0 (P = .01) in H1N1-positive patients and from 7.4 +- 4.1 to 3.0 +- 3.5 (P = .01) in H1N1-negative patients.
There was 1 death in the H1N1-positive patients (12.5%) thought to be due to pulmonary embolism and 1 death in the H1N1-negative group (20%) due to progression of multiple organ dysfunction syndrome.
In a related story from June of 2008, Hong Kong researchers were investigating zanamivir (Relenza) and two types of NSAIDS (Non-Steroidal Anti-Inflammatory Drugs) used to treat lab mice infected with H5N1.
Survivability increased 4-fold with this cocktail over zanamivir alone.
The NSAIDS used were celecoxib (Celebrex) and mesalazine, an NSAID used for inflammatory bowel disease. See Research Into Antiviral/NSAID Cocktail.
