1062Compassionate Use of Intravenous (IV) Zanamivir During the 2013-2014 Influenza Season: Case Series of Three Patients

Background. No IV antiviral agents for the treatment of severe influenza are currently approved in the U.S. Since 2009, IV zanamivir has been authorized for compassionate use through an Emergency Investigational New Drug (EIND) application to the Food and Drug Administration (FDA) as an investigational treatment for patients with serious influenza infection. We report the compassionate use of IV zanamivir in 3 patients at Cedars-Sinai Medical Center during the 2013-2014 influenza season. Methods. Use of IV zanamivir was approved by the institution’s investigational review board and an EIND was granted by the FDA for each patient. We performed a descriptive analysis of demographics, vaccination status, baseline co-morbidities, virologic test results, other antiviral treatments, supportive care modalities, treatment duration, adverse events and 30 day-outcome. Results. The decision to start IV zanamivir and the duration of therapy depended on the clinical judgment of the treating physician. IV zanamivir was initiated after a lack of clinical improvement from oseltamivir use. At the time of EIND request, all three patients were in the intensive care unit with respiratory failure and acute respiratory distress syndrome. All patients received a 5 day course of IV zanamivir. No medication related adverse events were identified. Please see the table for further details. Patient 1 Patient 2 Patient 3