香港流感怎样治疗

香港流感如何治疗配图，仅供参考

Treatment
The mainstay of treatment for influenza A and B are the neuraminidase inhibitors (NAI),mainly oseltamivir (Tables and ) . Doubling the treatment dose of oseltamivir in hospitalized patients with influenza does not seem to increase virologic efficacy,except perhaps for influenza B infections or in case of oral absorption concerns,with no evidence of emergence of oseltamivir resistance . Zanamivir is used less frequently than oral oseltamivir,likely due to the inhaled delivery route,although it has shown better activity against influenza B and few cross-resistance with oseltamivir.
Regarding intravenous formulations,if available,intravenous zanamivir or peramivir can be considered in SOT recipients who are severely ill despite oral oseltamivir,in case of concerns with oral absorption,although experience with these drugs in SOT recipients is lacking . Parenteral zanamivir is currently available in Europe,and a single dose intravenous peramivir has been approved in the United States for treatment of uncomplicated influenza infections. However,peramivir use in SOT likely would require repeated dosing or switching to oral oseltamivir to complete therapy.
NAI resistance is currently uncommon (0.09–1.9% of isolates),especially for influenza A/H3N2 and influenza B viruses,but remains an area of growing concern. In case of high-level oseltamivir resistance (such as H1N1 viruses strains with H275Y substitution),peramivir usually preserves reduced susceptibility,but zanamivir is usually active. Another common resistance mutation (H274Y in H3N2) confers resistance to both oseltamivir and peramivir,but not zanamivir. Therefore,peramivir should not be used in patients with oseltamivir resistance unless the isolate is proven to be susceptible (Tables and ). DAS181,an inhaled sialidase potentially inhibiting influenza and parainfluenza infection,has shown promising in vitro results of activity against oseltamivir-resistant influenza strains but failed to show superiority compared to placebo in previous studies in healthy subjects with influenza infection .
Treatment should be initiated as soon as possible since antiviral therapy is most likely to provide benefit when initiated within the first 48 h of illness in SOT,with a reduced rate of influenza-associated complications (admission to ICU,use of invasive ventilation,and death) . However,benefit has been demonstrated even with delayed treatment,and most experts endorse influenza-specific antiviral treatment at any point in the illness. Further,treatment should not be delayed while awaiting diagnostic testing results or if a rapid antigen IA test is negative when clinical symptoms are suggestive of infection due to the poor sensitivity of rapid antigen tests (Table ) .
In general,duration of antiviral therapy should be at least 5 days for SOT patients although some data suggest that longer duration (≥10 days) may be required,particularly in critically ill patients,those with pneumonia and persistent viral shedding.
Aside from advances in supportive care,no specific adjunctive therapies are routinely recommended. Corticosteroids have been shown to decrease the need for mechanical ventilation and progression to LRTI but at the cost of prolonged viral shedding and risk for invasive fungal coinfection. Corticosteroids are not routinely recommended but should be used if indicated for another reason such as concurrent acute rejection .","department":"