Efficacy of Clarithromycin-Naproxen-Oseltamivir Combination Therapy vs. Oseltamivir Alone for Hospitalised Paediatric Influenza Patients
Efficacy of Clarithromycin-Naproxen-Oseltamivir Combination Therapy vs. Oseltamivir Alone for Hospitalised Paediatric Influenza Patients
Efficacy of clarithromycin-naproxen-oseltamivir combination therapy vs. oseltamivir alone for
 hospitalised paediatric influenza patients
This study aimed to compare the safety and efficacy of clarithromycin-naproxen-oseltamivir
 combination therapy to that of oseltamivir treatment alone for hospitalised paediatric
 influenza patients. This prospective, single-blinded study included patients hospitalised for
 influenza infection aged 1 year to 18 years, at MacKay Children's Hospital, Taiwan, between
 December 2017 and December 2019. The primary outcomes were respiratory symptom severity and
 the signs that presented within hospitalisation. The durations of fever and hospital stay
 were also documented. The secondary outcome measures were serial changes in the virus titres,
 as detected by real-time polymerase chain reaction. Totally 54 patients were enrolled (28 in
 the control group and 26 in the combination group). There were no differences in the
 patients' baseline characteristics between the groups. The time to defervescence was
 significantly shorter in the combination group than the oseltamivir group (13.2 hours vs 32.1
 hours, p=0.002). The decrease in the virus titre was more pronounced from days 1 to 3 (log
 Δ13) in the combination group than the oseltamivir group.(log Δ13: 39% vs 19%, p=0.001). In
 paediatric settings, combination therapy may be used selectively among patients with a
 history of febrile convulsion or families anxious about the discomforts associated with the
 fever itself.
Inclusion Criteria:

 - age 1 year to 18 years; body temperature higher than 38 °C; presence of one of the
 following symptoms-cough, sputum production, sore throat, rhinorrhoea, myalgia, headache,
 or fatigue presenting within 72 hours from symptom onset; laboratory-confirmed influenza
 infection (including rapid test or PCR-confirmed influenza A or B); and clinical
 requirement for hospitalisation. Antiviral treatment was initiated within 48 hours after
 admission.

 Exclusion Criteria:

 - a history of allergy or contraindication to the study medications; the administration of
 medications with macrolides (ex: azithromycin, erythromycin), naproxen or neuraminidase
 inhibitor use within 72 hours; current use of any antibiotic; and the presence of an
 immunocompromised state due to steroid use, human immunodeficiency virus infection, chronic
 kidney disease, renal failure, chemotherapy or radiotherapy in half year, or innate
 immunodeficiency.