, Volume 39, Issue 5, pp 977-978
Date: 27 Feb 2013

Pharmacokinetics of oseltamivir carboxylate in critically ill patients: each patient is unique

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Dear Editor,

Patients infected with the 2009 H1N1 pandemic influenza virus often develop severe viral pneumonia with acute respiratory distress syndrome (ARDS) and multiple organ failure. High-dose oseltamivir (≥150 mg twice daily) has been advocated as optimal treatment [1]. However, the scientific evidence for this advice is lacking thus far [2]. Therefore, we explored the pharmacokinetics of oseltamivir and its active metabolite oseltamivir carboxylate in critically ill patients with H1N1 pandemic influenza following different dosing regimens.

All patients with H1N1 pandemic influenza admitted to the ICU of the University Medical Center Utrecht were eligible for inclusion. Patients received oseltamivir at a dose determined by their treating physician, and blood samples were drawn at t = 0, 1, 2, 3, 4 and 8 h on day three of treatment. Oseltamivir and oseltamivir carboxylate plasma concentrations were determined by HPLC–MS/MS [3]. The area under the concentration–time curve from 0 to