Swine flu patient treated with unlicensed drug: Lancet

Relenza,or zanamivir is currently only approved as an inhaled medicine. This version,however,did not work in the 22-year-old patient,whose immune system was impaired due to recent chemotherapy for Hodgkin’s disease. She reported to ICU within three days of reporting symptoms but her condition did not get better with Tamiflu.

She also did not respond to Tamiflu,or oseltamivir,which is given as a pill. Though this was not a case of resistance to Tamiflu,the woman was among the few in the world who failed to react to a treatment.

The doctors at UCL,therefore,decided to try intravenous Relenza in combination with high-dose corticosteroids and her condition improved within 48 hours. The researchers write that intravenous zanamivir 600 mg was administered twice daily. The unlicensed antiviral monotherapy was used only after an agreement for use was granted by the Hospital Formulary Committee and next of kin. Methylprednisolone was also started.

“Since her inflamed,atelectatic lungs were probably impeding adequate drug absorption and clinical improvement was not forthcoming,we decided to use intravenous (unlicensed) zanamivir. High dosing achieves effective respiratory epithelial concentrations and is well tolerated,” Dr I Michael Kidd from UCL and his colleagues explain in the report.

Intravenous zanamivir was started on ICU day 16 and by ICU day 21,H1N1 viral load had decreased over 100-fold,they report,adding: “Our patient progressively recovered with no drug-related side effects.”

“Although this is a single case report and direct cause and effect cannot be confirmed,the improvement in clinical status following intravenous Relenza encourages prompt further investigation,” Michael Kidd and Mervyn Singer reported.

Other flu drugs are under development to deal with seasonal and pandemic influenza. One that has shown promise in intravenous form is BioCryst Pharmaceuticals’s (BCRX.O) experimental product peramivir.

5 Doon students test H1N1 positive

Dehradun: Five children of the prestigious Doon school have tested positive for the H1N1 virus. The school had sent swab samples of 10 students to the Delhi-based National Institute of Communicable Diseases (NICD) last week. The report received from the NICD on Tuesday evening confirmed that five of them were positive. Dean Public Relations Piyush Malviya said,” Of the five boys who tested positive,four had already been sent home and have already recovered; one boy is quarantined in the school.”

“Parents are being informed of the latest developments. As a precautionary step,the school has cancelled classes,assemblie and other gatherings,” he added. ENS