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Medical Options in the Event of an Influenza Pandemic
that peramivir remains tightly bound to the neuraminidase (t
>24 hours), mouse model.
The disadvantage of monoclonal antibodies is the
whereas zanamivir and oseltamivir carboxylate dissociate rapidly from the possibility that viral mutations would render a monoclonal antibody
= 1.25 hours).
A single IM dose of peramivir up to 48 hours ineffective, and clinical studies to develop polyclonal immune globulin are
post-infection gave complete protection against a lethal dose of influenza currently under way.
in mouse models.
T-705 is a pyrazine derivative similar to ribavirin and is a potent inhibitor
Other antiviral agents are in
of RNA synthesis. Unlike the currently licensed anti-influenza agents, this
compound has activity against influenza A, B, and C viruses.
T-705 development, and offer intriguing
given up to 96 hours after infection was 89% protective against H5N1 in
insights into antiviral therapy in the
future, although currently their use
should be limited to controlled
…combination therapy with oseltamivir
and amantadine in a mouse model
increased the survival rate compared
Lastly, borrowing the paradigm of combination therapy from other
with single-drug therapy with either
infectious diseases, combination therapy with oseltamivir and amantadine
in a mouse model increased the survival rate compared with single-drug
therapy with either drug alone.
Early administration of convalescent blood products in the 1918 pandemic Based on currently available antivirals, oseltamivir at standard doses would
was shown to halve the mortality from 37% among controls to 16% be the primary treatment in the event of an influenza pandemic.
among treated patients.
As these were poorly designed studies, it is could be tried, with recognition of its limitations as discussed above.
unclear whether the perceived benefit was due to antibodies in the plasma Rimantidine and amantadine would generally not be used for pandemic
or other factors. influenza unless the circulating strain was known to be susceptible or other
antivirals were not available.
Other antiviral agents are in development,
Several monoclonal antibodies demonstrated 100% efficacy in preventing and offer intriguing insights into antiviral therapy in the future, although
death up to 72 hours after infection in a lethal H5N1 Vietnam 1203/04 currently their use should be limited to controlled clinical trials. ■
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