Intravenous zanamivir for influenza myocarditis and enteral malabsorption
KeywordsInfluenza Myocarditis Drug malabsorption Extracorporeal life support
Acute myocarditis is an uncommon complication of influenza with a high mortality . Early therapy with neuraminidase inhibitors (NI) is recommended in patients hospitalized for influenza, notably those with myocarditis. Oral oseltamivir is generally used as the first line NI therapy, whereas parenteral zanamivir and peramivir represent alternatives in selected patients who might not respond to oseltamivir, as may occur in conditions of gut failure and defective enteral drug absorption [2, 3]. We present two patients with influenza myocarditis complicated by enteral drug malabsorption, who received early intravenous zanamivir therapy with excellent clinical outcomes.
In these two patients with influenza myocarditis and refractory cardiogenic shock, the rapid identification of poor drug absorption using a simple paracetamol absorption test allowed the early introduction of parenteral zanamivir instead of oral oseltamivir, with excellent clinical outcomes. Since drug malabsorption is frequent in critically ill patients with circulatory shock , we propose that a paracetamol pharmacokinetic study be performed early in patients with influenza myocarditis and cardiogenic shock to avoid any delay in the administration of parenteral therapy if enteral drug malabsorption is demonstrated.
Availability of data and materials
The datasets used during the current study are available from the corresponding author on reasonable request.
FPJ, data collection and analysis and writing the manuscript. NBH, data collection and analysis, writing the manuscript, and submission. MK, data collection and analysis and writing the manuscript. AR, data collection and analysis and writing the manuscript. LL, data collection and analysis and writing the manuscript and final revision. All authors read and approved the final manuscript.
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Retrospective collection of data. Standard of care.
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