He C H, Liu C Y, Lin G Y, Peng Q, Liao J Y, Lin J H, Zhang T, Zheng X F, Lin C X, Wang S J, Chen R S, Deng L, Chen Y M
Department of Respiratory Diseases, Guangzhou Women and Children's Medical Center, Guangzhou 510120, China; He Chunhui contributed equally to this article.
Department of Pediatrics, Shenzhen Baoan District Maternity and Child Care Service Centre, Shenzhen 518133, China; Liu Chunyi contributed equally to this article.
Zhonghua Er Ke Za Zhi. 2017 Jun 2;55(6):462-467. doi: 10.3760/cma.j.issn.0578-1310.2017.06.014.
To evaluate the efficacy and safety of oseltamivir in the treatment of suspected influenza in children. A multicenter, randomized and open-label trial was conducted among 229 individuals with suspected influenza which were collected from the clinic of 5 hospitals in Guangdong province (Guangzhou Women and Children's Medical Center, Shenzhen Baoan District Maternity and Child Care Service Center, the Second Affiliated Hospital of Shantou University Medical College, Dongguan Maternity and Child Care Service Centre, Yuexiu District Children's Hospital of Guangzhou) from April to July 2015. They were randomized either to oseltamivir group (oseltamivir 30-75 mg, twice daily for 5 days) or control group who were given symptom relief medicines for 5 days. No significant difference was found between two groups in influenza symptoms of the patients before the treatment(>0.05). Altogether 229 individuals (114 in oseltamivir group, 115 in control group) were analyzed for efficacy, in which 73 individuals (42 oseltamivir, 31 control), 31.9%, were identified as influenza-infected through laboratory test. No significant difference was found between the two groups in the duration of fever although shortened. In the 229 individuals , the cumulative alleviation proportion between oseltamivir and control group was not significantly different (>0.05): the median duration of illness was 69.9 hours (95% 65.3-91.5) in oseltamivir group and 75.4 hours (95% 63.9-91. 7) in control group; the median duration of fever was 40.4 hours (95% 31.5-53.4) in oseltamivir group and 44.0 hours (95% 33.2-50.0) in control group. In the 73 individuals, the cumulative alleviation proportion between oseltamivir and control group was significantly different (<0.05). The median duration of illness was 61.2 hours (95% 48.0-121. 0) in oseltamivir group, being significantly shorter than that of 116.0 hours (95% 91.5-175.0) in control group. But it was not significantly different that the median duration of fever was 32.8 hours (95% 24.0-47.0 ) in oseltamivir group and 55.8 hours (95% 43.6-78.3 ) in control group (>0.05). And the median duration of fever in 60 individuals (38 oseltamivir, 22 control) was significantly different between two groups(<0.05), who had finished a course of taking oseltamivir in the 73 individuals, 34.8 hours (95% 24.0-48.5 ) in oseltamivir group being significantly shorter than that of 53.3 hours (95% 43.6-104.0 ) in control group. There was certain difference in side effects rate between the two groups (oseltamivir 10%, control 2%, <0.05). The main side-effects were gastrointestinal symptoms (stomachache, diarrhea, poor appetite, vomiting). The duration of illness and fever in suspected influenza patients treated with oseltamivir was shorter than those in the patients treated with no oseltamivir, the difference was not statistically significant, when 31.9% was confirmed with positive result of virus test in suspected influenza in children. But in these patients with positive result of virus test, the duration of illness was significantly shortened with treatment with oseltamivir as compared with no treatment with oseltamivir, and it would be better if full oseltamivir course was completed for reducing the duration of fever. Oseltamivir treatment was safe with mild side effects.
评估奥司他韦治疗儿童疑似流感的疗效和安全性。对2015年4月至7月从广东省5家医院(广州市妇女儿童医疗中心、深圳市宝安区妇幼保健院、汕头大学医学院第二附属医院、东莞市妇幼保健院、广州市越秀区儿童医院)门诊收集的229例疑似流感患者进行了一项多中心、随机、开放标签试验。他们被随机分为奥司他韦组(奥司他韦30 - 75mg,每日2次,共5天)或对照组,对照组给予对症缓解药物5天。治疗前两组患者的流感症状无显著差异(>0.05)。共对229例患者(奥司他韦组114例,对照组115例)进行了疗效分析,其中73例(奥司他韦组42例,对照组31例),占31.9%,通过实验室检测确诊为流感感染。两组发热持续时间虽有缩短但无显著差异。在229例患者中,奥司他韦组与对照组的累积缓解比例无显著差异(>0.05):奥司他韦组疾病中位持续时间为69.9小时(95% 65.3 - 91.5),对照组为75.4小时(95% 63.9 - 91.7);奥司他韦组发热中位持续时间为40.4小时(95% 31.5 - 53.4),对照组为44.0小时(95% 33.2 - 50.0)。在73例确诊患者中,奥司他韦组与对照组的累积缓解比例有显著差异(<0.05)。奥司他韦组疾病中位持续时间为61.2小时(95% 48.0 - 121.0),显著短于对照组的116.0小时(95% 91.5 - 175.0)。但奥司他韦组发热中位持续时间为32.8小时(95% 24.0 - 47.0),对照组为55.8小时(95% 43.6 - 78.3),差异无统计学意义(>0.05)。在73例完成奥司他韦疗程的60例患者(奥司他韦组38例,对照组22例)中,两组发热中位持续时间有显著差异(<0.05),奥司他韦组为34.8小时(95% 24.0 - 48.5),显著短于对照组的53.3小时(95% 43.6 - 104.0)。两组副作用发生率存在一定差异(奥司他韦组10%,对照组2%,<0.05)。主要副作用为胃肠道症状(腹痛、腹泻、食欲减退、呕吐)。在儿童疑似流感患者中,31.9%病毒检测呈阳性,接受奥司他韦治疗的患者疾病和发热持续时间短于未接受奥司他韦治疗的患者,但差异无统计学意义。但在这些病毒检测呈阳性的患者中,与未接受奥司他韦治疗相比,奥司他韦治疗可显著缩短疾病持续时间,且完成奥司他韦全疗程对缩短发热持续时间效果更佳。奥司他韦治疗安全,副作用轻微。