{"id":217,"date":"2008-12-23T11:37:00","date_gmt":"2008-12-23T16:37:00","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=217"},"modified":"2015-06-04T15:31:31","modified_gmt":"2015-06-04T19:31:31","slug":"flu-resistance-to-oseltamavir-the-bugs-win-again","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/flu-resistance-to-oseltamavir-the-bugs-win-again\/2008\/12\/23\/","title":{"rendered":"Flu Resistance to Oseltamivir: The Bugs Win Again"},"content":{"rendered":"

\"\"<\/a>I must admit, the recent report that 49 of the 50\u00a0H1N1 flu viruses tested by the CDC are resistant to oseltamivir<\/a> caught me by surprise.\u00a0 For the non-math majors among the readership, that’s a 98% resistance rate.<\/em>\u00a0 Yikes.<\/p>\n

Actually, the rate of resistance is so high that at first I didn’t believe it when my wife told me — thought she’d flipped the numbers.\u00a0 “You mean that 1 of 50 was resistant,” I insisted — wrongly.\u00a0 As usual, the pediatrician has the accurate news on the latest outbreak — I should have learned that long ago.<\/p>\n

So … what happened?\u00a0 Last year the resistance rate was only 10%, and it’s not as if\u00a0since then\u00a0we’ve put oseltamivir in the drinking\u00a0water.\u00a0 The bulk of people with influenza never get diagnosed or<\/em> treated, so it can’t be due to excessive prescribing on the part of clinicians.\u00a0 I doubt there’s much\u00a0in the way of\u00a0off-label or illicit use, and certainly nothing like this is showing up in my spam filter:\u00a0<\/p>\n

Brand name T-A-M-I-F-L-U cheap!\u00a0 From bestcanadapharmacy.com<\/p><\/blockquote>\n

One smart virologist I know suggested it\u00a0might be the result of preventive programs in nursing home-type settings during flu outbreaks.\u00a0 These preventive treatments can go on for weeks, so if the resistant viruses have any sort of evolutionary advantage, they could become the dominant strain.\u00a0<\/p>\n

For now, interim guidelines for management of patients with influenza are available here<\/a>.\u00a0 We’ll be using zanamivir (must be the best name for an antiviral ever <\/em>— too bad it can’t be used in kids or patients with asthma), and our old friend rimantadine — though this latter drug has no activity against influenza B, and of course H3N2 viruses are already likely to be resistant.\u00a0<\/p>\n

Or we’ll be using nothing but TLC, which is kind of where we were several years ago.\u00a0 And chalk another one up for the bugs, they are (in aggregate) pretty darn smart.<\/p>\n","protected":false},"excerpt":{"rendered":"

I must admit, the recent report that 49 of the 50\u00a0H1N1 flu viruses tested by the CDC are resistant to oseltamivir caught me by surprise.\u00a0 For the non-math majors among the readership, that’s a 98% resistance rate.\u00a0 Yikes. Actually, the rate of resistance is so high that at first I didn’t believe it when my […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,7,8,9],"tags":[167,485,500,682,801,815,894,1002],"class_list":["post-217","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-misc","category-patient-care","category-policy","tag-cdc","tag-idsa","tag-influenza","tag-oseltamivir","tag-resistance","tag-rimantadine","tag-tamiflu","tag-zanamivir"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/217","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=217"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/217\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=217"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=217"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=217"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}