Early versus late oseltamivir treatment in severely ill patients with 2009 pandemic influenza A (H1N1): speed is life.

The need for early antimicrobial therapy is well established for life-threatening bacterial and fungal infections including meningitis and sepsis/septic shock. However, a link between the outcome of serious viral infections and delays in antiviral therapy is not as well recognized. Recently, with the occurrence of the influenza A/H1N1 pandemic of 2009, a large body of data regarding this issue has become available. Studies analysing data from this pandemic have consistently shown that delays in initiation of antiviral therapy following symptom onset are significantly associated with disease severity and death. Optimal survival and minimal disease severity appear to result when antivirals are started as soon as possible after symptom onset.