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Antibiotics in pandemic flu

BMJ 2006; 332 doi: (Published 02 February 2006) Cite this as: BMJ 2006;332:248
  1. Marc J M Bonten, professor of molecular epidemiology of infectious diseases (,
  2. Jan M Prins, internist and infectious diseases physician
  1. Division of Medicine, Infectious Diseases and Geriatrics, Eijkman Winkler Institute for Microbiology, Inflammation and Infectious Diseases, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, 3584 CX Utrecht, Netherlands
  2. Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, and Center of Infection and Immunity Amsterdam, Academic Medical Centre, 1105 AZ Amsterdam, Netherlands

    Will be essential for treating, but not preventing, bacterial pneumonia

    With the continuing spread of avian H5N1 influenza a possible pandemic of human influenza becomes more likely. If a pandemic started soon no effective vaccine would be available and there would probably be a shortage of antiviral drugs. There is no evidence (yet) of the effectiveness of neuraminidase inhibitors in case of avian and pandemic influenza viruses,1 and mortality among patients infected with H5N1 bird flu remains high, despite the use of neuraminidase inhibitors.2 Resistance to antiviral drugs, which may even develop during treatment, might further limit the efficacy of these drugs.3 Given that secondary bacterial infection is an important and often fatal complication of influenza, antibiotics will also have a critical role in the event of a human pandemic.

    In 1918-19, when antibiotics were not available, pandemic flu caused 20 million to 100 million deaths worldwide, with an estimated case fatality rate of between 2% and …

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