Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Hung IFN et al. Chest 2017 May.

Combined therapy with a macrolide, a nonsteroidal anti-inflammatory drug, and a neuraminidase inhibitor helped.

As many as 500,000 influenza deaths occur worldwide annually, with unpredictable outbreaks and no therapeutic interventions that improve outcomes other than symptom duration (NEJM JW Gen Med Mar 1 2015 and Lancet 2015; 385:1729). Hong Kong investigators evaluated whether oseltamivir, combined with clarithromycin and naproxen — which have in vitro activity against influenza — benefitted hospitalized patients with confirmed influenza A(H3N2).

In this single-center, open-label, randomized clinical trial, 217 patients (median age, 80) with confirmed influenza A and radiography-confirmed infiltrates who presented within 72 hours of symptom onset were randomized to either clarithromycin plus naproxen plus oseltamivir (for 2 days, followed by 3 days of oseltamivir alone) or to oseltamivir alone (for 5 days). All patients received β-lactam empirical therapy for community-acquired pneumonia. Intent-to-treat analysis revealed that the combination group had significantly lower 30-day mortality (1% vs. 8%; number needed to treat [NNT], 14) and 90-day mortality (2% vs. 10%; NNT, 13), as well as shorter median hospital length of stay (2 days vs. 3 days). Viral titers at 24 hours also were significantly lower in the combination group than in the monotherapy group. No atypical bacterial coinfections were detected in either group.

CITATION(S):

Hung IFN et al. Efficacy of clarithromycin-naproxen-oseltamivir combination in the treatment of patients hospitalized for influenza A(H3N2) infection: An open-label randomized, controlled, phase IIb/III trial. Chest 2017 May; 151:1069.

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