Influenza模板模板模板.ppt

Avian influenza A H7N9 virus appears to have derived from multiple reassortment events of several avian influenza viruses Antivirals The two classes of antiviral drugs used against influenza neuraminidase inhibitors Oseltamivir奥司他韦 Zanamivir 扎那米韦 against influenza A and B M2 protein inhibitors adamantane金刚烷胺 only active against influenza A Antivirals When initiated promptly（ within the first 24 to 30 hours ）, antiviral therapy can shorten the duration of influenza symptoms Some studies have suggested that antiviral therapy reduces the severity and incidence of complications of influenza ，the duration of hospitalization in patients with severe influenza ，and influenza-associated mortality Oseltamivir奥司他韦 In meta-analyses, treatment with oseltamivir reduced the median duration of symptoms by 0.9 days in otherwise healthy adults and by 0.4 days in elderly adults or patients with comorbidities The prevailing impression has been that there is little or no benefit when treatment is initiated two days or more after the onset of uncomplicated influenza. 1, Cochrane Database Syst Rev， 2012 2, BMJ 2003; 326:1235 Zanamivir 扎那米韦 In a 2003 meta-analysis of randomized trials, zanamivir reduced the median duration of symptoms of laboratory-confirmed influenza by 1.3 days in otherwise healthy adults ≤65 years of age and by two days in adults ≥65 years of age or patients with comorbidities. Subsequent meta-analyses have shown similar benefits Antivirals 奥司他韦 orally administered , good bioavailability ,widely distributed in the body Dosing: 75 mg twice daily for five days Primarily excreted by the kidneys 扎那米韦 10 mg [2 inhalations] twice daily for five days 慎用于哮喘、COPD Antivirals 奥司他韦 关于疗程： recommended duration 5 days longer duration considered in severely ill patients or immunosuppressed individuals 关于剂量 150 mg twice daily VS. 75mg twice daily No differences in mortality , median days of supplemental oxygen, or mechanical ventilation BMJ 2013; 346 The United States Adviso