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Case Reports in Infectious Diseases
Volume 2015 (2015), Article ID 504975, 4 pages
http://dx.doi.org/10.1155/2015/504975
Case Report

Treatment of Immunocompromised, Critically Ill Patients with Influenza A H1N1 Infection with a Combination of Oseltamivir, Amantadine, and Zanamivir

1Wilhelmina Children’s Hospital, University Medical Center Utrecht, Lundlaan 6, P.O. Box 85090, Utrecht, Netherlands
2Department of Pharmacy & Pharmacology, Slotervaart Hospital, 1066 EC Amsterdam, Netherlands
3Department of Clinical Pharmacy, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
4Department of Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
5Department of Hematology, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
6Department of Virology, Erasmus Medical Center, 3015 CE Rotterdam, Netherlands
7Department of Intensive Care, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands
8Department of Virology, Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands

Received 30 May 2015; Revised 21 July 2015; Accepted 28 July 2015

Academic Editor: Ian Barr

Copyright © 2015 Wouter J. Meijer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Immunocompromised patients are at increased risk of complications of influenza virus infection. We report on two critically ill patients on immunosuppressive medication with influenza pneumonia. In both patients, oseltamivir monotherapy did not result in clearance of the virus after 18 and five days, respectively. After adding zanamivir and amantadine to the treatment, PCRs on pharyngeal and/or plasma specimens turned negative in both patients after four and three days, respectively. We suggest, that in critically ill patients with influenza A H1N1 infection, treatment efficacy should be monitored closely and treatment with a combination of antiviral drugs should be considered.