Clinical Efficacy Assessment Of Antiviral-Antibiotic Combination Therapy For Prevention Of Complications Associated With Severe Influenza Infection
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Date
2021-03
Authors
Ishaqui, Azfar Athar
Journal Title
Journal ISSN
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Publisher
Universiti Sains Malaysia
Abstract
Secondary bacterial infections, mechanical respiratory support, and multi-organ failure are the complications associated with severe Influenza infection responsible for the mortalities and morbidities worldwide. The use of antibiotics in viral influenza infection is still debatable. The current study aimed to compare the efficacy of Antiviral drug therapy alone and Antiviral-Antibiotic combination therapy in prevention of complications associated with Influenza infection hospitalized patients. This two-center, retrospective cohort study was conducted in two tertiary care teaching hospitals in Saudi Arabia. Laboratory confirmed Influenza-A (non-H1N1), Influenza-B, Influenza-A (H1N1) hospitalized patients who presented in the emergency room after 48 hours of symptoms onset were identified and divided into two groups; Group-1 patients were initiated on Antiviral alone drug therapy while Group-2 patients were initiated on Antiviral-Antibiotic combination therapy. Both group patients were evaluated for different clinical outcomes, such as incidences of influenza associated secondary bacterial infections, the need for respiratory support, length of hospitalization stay, incidences of multi-organ failure, early clinical failure, and time to clinical stability. Comparative efficacy analysis of Antiviral alone therapy patients vs. Antiviral-Antibiotic combination therapy patients for Influenza-A (non-H1N1) strain (212 vs. 187 patients), Influenza-B (153 vs. 131 patients), and Influenza-A (H1N1) strain (227 vs. 286 patients) revealed that incidences of secondary bacterial infection, need of respiratory support, incidences of ICU admission, length of hospitalization stay and time to clinical stability was statistically significant less for patients initiated on Antiviral-Antibiotic combination therapy for all three Influenza strains. The rapidity of symptoms relief was evident for Antiviral-Antibiotic combination therapy patients as the mean Acute Respiratory Infection symptom score was statistically significant low on hospitalization Day-4 (14.9 vs. 12.2; P<0.001) for Influenza-A (H1N1) patients while hospitalization Day-3 for Influenza-A (non-H1N1) and Influenza-B patients (12.9 vs 11.6, P= 0.039; 12.5 vs. 11.8, P= 0.007). Oseltamivir-Azithromycin combination was found to be the most effective combination therapy for the rapidity of symptoms relief. Among elderly patients (age >50 years), patients initiated on Antiviral-Antibiotic combination therapy were found to have statistically significant fewer secondary bacterial infections, fewer incidences of need for respiratory support, and shorter length of hospitalization stay for all three Influenza strains. Survival analysis revealed that the Antiviral-Antibiotic combination was associated with reduced 90-Day mortality among Influenza-A (H1N1) and Influenza-A (non-H1N1) strain patients (9.4% vs. 3.7%, P= 0.029; 6.6% vs. 2.8%, P= 0.044). Early initiation of Antiviral-antibiotic combination therapy was found to be more efficacious than Antiviral therapy alone in the prevention of severe Influenza infection-associated complications, especially in high-risk patients such as elderly patients, unvaccinated patients, and patients whom antiviral is initiated after 48 hours of symptoms onset.
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Keywords
Pharmacy