A report published in the Dec. 22 issue of the New England Journal of Medicine showed that half of eight Vietnamese patients infected with the H5N1 virus died, despite the use of the anti-flu drug Tamiflu. In two of the fatalities, the virus had developed resistance to the drug. This phenomenon merits more attention, with regard to the proper dosages and period of treatment that should be employed.
In this study, the virus did not initially develop resistance to Tamiflu, so the disease is curable. However, in the case of the two fatalities, resistance to the drug appeared after the patients had been treated for four and eight days, respectively -- showing that such treatment may trigger resistance in certain patients and result in their deaths.
Tamiflu can suppress virus reproduction. A five-day treatment, with two doses of 75mg per day, is often recommended. But it has long been known that resistance may develop during treatment. Since children have lower immunity and carry more influenza viruses, studies suggest that the chance of resistance to the drug developing in children is higher than that in adults.
Despite the development of resistance to Tamiflu, patients treated with the drug always recovered in the past -- a phenomenon that was emphasized by the medical community. But caution is needed in the face of a new type of virus that may mutate drastically, because past experience may not be applicable to the new strain of the virus.
When bird flu attacks humans, the virus may reproduce on a massive scale and spread through patients' bodies, remaining in respiratory passages longer than regular types of flu. This is just like the example of treating children. Without stronger doses administered over a longer period of time, treatments may fail, due to resistance or a course of treatment which is too short.
In Taiwan's preparation plan for bird flu, the suggestion for anti-flu treatment based on past experience is too conservative. In the face of a virus mutation, the old rule of a five-day course of treatment should be discarded.
Such experience is a reminder not to abuse anti-flu drugs, because if they are abused there may be no effective medicine to use in the future. Statistics show that Japanese people consume more than 10 million doses of Tamiflu every year. As a result, resistance is likely to build up. Such abusive usage is wrong. When the H5N1 virus was first detected in Hong Kong in 1997, Amantadine, another popular anti-flu drug, was effective in treating the disease. Unfortunately, it is completely ineffective now. Such resistance would not have occured if the drug had not been used. Farmers in epidemic areas may even have been adding Amantadine to bird feed in recent years. Obviously, this is the negative result of abusing anti-flu drugs.
In the face of resistance to Tamiflu, the public should not panic, but it is necessary for us to come up with response measures. For example, Tamiflu should not be hoarded or abused and Relenza and other anti-flu drugs should be purchased. Also, researchers should study the safety of heavier dosages and longer courses of treatment of Tamiflu.
In fact, anti-flu drugs are only a small part of the prevention of new types of flu. There are more important issues, such as vaccines and other preventive measures. After all, SARS was defeated without any drugs or vaccines. This experience proved that prevention is also a great weapon in combatting new types of flu.
Lee Ping-ing is an associate professor at the Department of Pediatrics at National Taiwan University Hospital.
TRANSLATED BY EDDY CHANG
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