Combination Treatment for Hospitalized Influenza
SOURCE: Hung IFN, To KKW, Chan JFW, et al. Chest 2017;15:1069-1080.
Was I the only clinician who was unaware that either clarithromycin or naproxen possess antiviral activity? In their opening discussion of the topic, Hung et al commented, “In vitro and animal studies have shown that ... clarithromycin and naproxen ... both possess antiviral activity. ... In addition, macrolides have effects on the host response to influenza virus infection.” Who knew?
In the United States, thousands of people die each year from influenza. The effect of “traditional” antiviral therapy, most commonly neuraminidase inhibitors, often is limited by the fact that patients are admitted more than 48 hours after symptom onset, rendering neuraminidase inhibitors less effective.
Patients admitted to the hospital (n = 217) with confirmed influenza A (H3N2) were randomized to five days of treatment with oseltamivir 75 mg twice daily, plus either clarithromycin 500 mg + naproxen 200 mg twice daily for the first two days or placebo.
There was a dramatic, statistically significant effect of the combination therapy on mortality. Of the 10 deaths in the 30-day follow-up, nine were in the neuraminidase monotherapy group. Confirming that this is unlikely to be related to the antibacterial effects of clarithromycin, the authors indicated that < 5% of these patients had confirmation of bacterial coinfection at presentation. Clinicians may want to consider such a regimen for hospitalized influenza pneumonia patients.
Patients admitted with confirmed influenza A and who were randomized to oseltamivir plus clarithromycin and naproxen demonstrated a dramatic improvement.
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