Bird Flu Treatment and Bangladesh

Use
· For Treatment -
In order for Oseltamivir to be effective as treatment for avian influenza infection, the medication must be administered as early as possible, within 48 hours of symptom onset.
· For Prophylaxis -
Chemoprophylaxis or prophylaxis is the administration of a drug to prevent disease from developing in someone who has been exposed but is not yet ill. Therapy should begin as soon as possible within 2 days of exposure or for those persons who will go for curling of chickens.

Oseltamivir Oral Formulations
· Capsules 75 mg each
– 10 capsules per box
– Manufacturer: Roche/Beximco/Eskayef
– Brand name—Tamiflu®/Ossiflu®/SKflu®
– Store at room temperature (15 - 300C)

· Liquid Suspension ( not available in Bangladesh yet)
– White powder mixed with 23 mL of drinking water
– Fruit flavored
– Refrigeration required
– Use within 10 daysOral dispenser included

Oseltamivir Treatment Regimen
• Adults: 75 mg two times a day for 5 days
• Not approved for children less than 1 year of age
• Children > 1 year old:
<15> 40 kg 75 mg twice daily

Oseltamivir Chemoprophylaxis Doses

Patient Age Prophylactic Dose
i) > 13 years 1 capsule (75 mg) once a day
ii) 1 to 12 years
<> 40 kg: 75 mg once a day
Duration of prophylaxis depends on epidemiologic setting. Post-exposure use is typically for 7 to 10 days.

Oseltamivir Side Effects
• Headache (20%)
• Nausea (10%)
• Vomiting (9%)
• Fatigue (8%)
• Diarrhea (7%)
• Cough (6%)
• Bronchitis, abdominal pain, dizziness (2%)
• Insomnia, vertigo (1%)

Contraindications & Precautions

• Pregnant or breastfeeding mothers

No recognized birth defects in pre-clinical testing

No human clinical studies demonstrating safety or efficacy

Use if benefit outweighs risk

• Liver diseases

Safety and efficacy not yet evaluated

• Kidney diseases

Decrease dose based on creatinine clearance

Bird Flu Drug and Bangladesh

• Classes of Anti-virals
  Neuraminidase inhibitors
  – Oseltamivir* (TamifluTM, Ossiflu, SKflu etc.)
  – Zanamivir (RelenzaTM)
  Adamantanes
  – Amantadine
  – Rimantadine
  
• Commercial Drugs

1. Ossiflu is produced by Beximco Pharmaceuticals and SKflu by Eskayef of Bangladesh. But they produce these drugs only for WHO to distribute through government control and not available commercially in the market because –
a) To prevent indiscriminate use of this drug,
b) To prevent the development of rapid resistance.

2. The neuraminidase inhibitors Oseltamivir and Zanamivir are effective against influenza A and B, including H5N1 and other avian influenza viruses.

3. Although antiviral resistance may occur with Oseltamivir treatment, it is currently the primary antiviral to be used for pandemic containment. The World Health Organization (WHO) therefore has stockpiles of Oseltamivir for rapid response.