Katedra za farmakologiju i toksikologiju
Medicinski fakultet Univerziteta u Kragujevcu
Available treatment approaches of acute influenza H1N1 infection and its clinical complications
Mihajlo Jakovljević and Stepanović Marija
Faculty of Medicine University of Kragujevac
Human H1N1 pandemic developed from the originally localized Mexican source early in the spring 2009. It seems that the current wave of infections slowly moves towards the southern hemisphere; however, the WHO reports on certain foci in Southeast Asia, Western Africa and tropic islands of the Middle America do not exclude another reccurrence in the northern hemisphere. This drew the attention of epidemiologists due to the fact that the virus owns a very unique capsid which expresses proteins coded by genes originating from the human, swine and avian influenza virus and was not covered by the available seasonal vaccines. Although most of the cases exibit classical clinical presentation of influenza infection, there are special features like significant gastrointestinal symptomatology and vulnerability of the young population. With respectively small but significant portion of patients there have been noticed fulminant course of infection with poor prognosis including sudden development of respiratory failure and consciousness disturbances which require intensive care unit admission. Cytokine storm should be mentioned as one of the key pathogenic events contributing to the overall mortality in substantial portion of patients. If active immunization is assumed to be preventive measure of proven efficacy, clinicians are still in doubt how to treat a complicated course of infection. We should be aware that the first choice essential drugs, for which viral sensitivity has been certainly proved, are neuraminidasis inhibitors. Here we have to distinct between more available oseltamivir and less available zanamivir and peramivir which until now have shown absolute effectiveness in inhibiting viral strains replication in vivo. Success of direct antiviral protocols has also been noticed with inhaled synthetic nucleoside ribavirine applied locally. Bacterial pneumonia superimposed by the overall patient status should be treated in accordance with the available evidence-based guidelines. We should be aware that septic lung infection caused by multiresistant organisms irrespective of intensive treatment remains the main cause of lethal outcomes in serious clinical presentations of H1N1 infection. Acta Medica Medianae 2010;49(3):76-82.
Key words: Influenza H1N1, treatment, antiviral drugs, pandemic