Zanamivir
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Liver injury and renal impairment in a child: case report A 2-year-old child [sex not stated] developed renal impairment and liver injury during treatment with zanamivir for influenza A virus H1N1 subtype. The child experienced deteriorating respiratory function 4 days post-transplantation, leading to mechanical ventilation. Oseltamivir was started 3 days after symptom onset; however, worsening respiratory distress prompted the introduction of IV zanamivir 2 x 260 mg/day on posttransplant days 10–15. During treatment the child’s liver function deteriorated as indicated by an increase in ALT (193 U/L) and AST levels (628 U/L). An ultrasound showed a retrograde flow of the portal vein but not portal vein thrombosis. Rejection was excluded by a liver biopsy. To increase hepatic venous outflow, positive end-expiratory pressure (maximum 16 cmH2O) was gradually decreased, without an effect. Serum creatinine level increased from 0.36 mg/dL to a maximum of 0.68 mg/dL during zanamivir treatment. Zanamivir was discontinued and kidney function normalised. Portal vein flow normalised 10 days later. Oseltamivir was continued for a further 10 days. The child’s condition gradually improved and they were weaned off mechanical ventilation after 25 days. Tracheal aspirate was negative for H1N1 RNA 22 days after first detection. Dohna-Schwake C, et al. Severe H1N1 infection in a pediatric liver transplant recipient treated with intravenous zanamivir: efficiency and complications. 803036536 Transplantation 90: 223-4, No. 2, 27 Jul 2010 - Germany
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Reactions 11 Sep 2010 No. 1318
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