Sandbox mona

• Influenza A and B

• Adults

• Preferred regimen:Oseltamivir (Tamiflu)75 mg bid for 5 days OR Zanamivir(Relenza) 10 mg (two 5-mg inhalations)bid for 5 days OR Peramivir(Rapivab) One 600 mg dose, via intravenous infusion for 15-30 minutes for 1 day

• Children

• Preferred regimen:Oseltamivir If younger than 1 yr old: 3 mg/kg/dose bid

• If 1 yr or older, dose varies by child’s weight:

15 kg or less, the dose is 30 mg bid
 >15 to 23 kg, the dose is 45 mg bid ;
>23 to 40 kg, the dose is 60 mg bid;
 >40 kg, the dose is 75 mg bid  for 5 days OR

• Zanamivir(Relenza) 10 mg (two 5-mg inhalations)bid
• Note:FDA approved and recommended Peramivir(Rapivab) for use in adults ≥18 yrs

• Dosing in Adult Patients with Renal Impairment

• Oral oseltamivir
• Creatinine clearance 61 to 90 mL/min-75 mg twice a day
• Creatinine clearance 31 to 60 mL/min-30 mg twice a day
• Creatinine clearance 10 to 30 mL/min-30 mg once daily
• ESRD Patients on Hemodialysis
• Creatinine clearance ≤10 mL/min-30 mg after every hemodialysis cycle. Treatment duration not to exceed 5 days
• ESRD Patients on Continuous Ambulatory Peritoneal Dialysis-A single 30 mg dose administered immediately after a dialysis exchange

• Intravenous Peramivir (single dose)
• Creatinine clearance >50 mL/min-600mg
• Creatinine clearance 30 to 49 mL/min-200mg
• Creatinine clearance 10 to 29 mL/min-100mg
• ESRD Patients on Hemodialysis-Dose administered after dialysis at a dose adjusted based on creatinine clearance

• 1.Keratitis

• Preferred regimen: Miltefosine OR Voriconazole.

• 2. Acanthamoeba Granulomatous Amebic Encephalitis and Disseminated Disease

• Preferred regimen: Adults: Success with IV Pentamidine AND Sulfadiazine AND Flucytosine AND (Fluconazole OR Itraconazole )
• Note: 2 children responded to PO rx: TMP-SMX AND Rifampin AND Ketoconazole

• Primary amoebic meningoencephalitis

• Preferred regimen: Amphotericin B 1.5 mg/kg /day bid for 3 days; then 1 mg/kg/day for 6 days AND1.5 mg/day intrathecal x 2 days; then 1 mg/day intrathecal qd for 8 days.
• Note: Investigational drug called miltefosine also available for treatment.

avian flu

• Preliminary evidence demonstrates that neuraminidase inhibitor can reduce the duration of viral replication and improve survival among patients with avian influenza. In cases of suspected avian influenza, one of the following 3 neuraminidase inhibitors should be administered as soon possible, preferably within 48 hours of symptom onset.

• 1.Preferred regimen:Oseltamivir 75 mg PO qd for a minimum 10 days

• Note:Patients with severe disease may have diarrhea and may not absorb oseltamivir efficiently

• 2.Patients has diarrhea and malabsorption

• Preferred regimen:Zanamivir10 mg inhaled bid for minimum 5 days OR Peramivir600 mg IV as a single dose for1 day
• Note(1): The use of corticosteroids is not recommended.
• Note(2): Physicians may consider increasing either the recommended daily dose and/or the duration of treatment in cases of severe disease.
• Note(3):The use of amantadine is not recommended as most H5N1 and H7N9 avian influenza viruses are resistant to it.
• Note(4):Supportive care is also an important cornerstone of the care of patients with avian influenza. Considering the severity of the illness and the possible complications, patients may require fluid resuscitation, vasopressors, intubation and ventilation, paracentesis, hemodialysis or hemofiltration, and parentral nutrition.