Intravenous N-acetylcysteine and Oseltamivir Versus Oseltamivir in Adults Hospitalized With Influenza and Pneumonia

• Status: Not yet recruiting
• Trial end date: 2022-11-30
• Target enrollment: 0
• Participant gender: All

Summary

Seasonal influenza epidemics are important causes of morbidity and mortality. Cytokine dysregulation, with high levels of pro-inflammatory cytokines, occurs in patients with severe influenza. Early therapy with a neuraminidase inhibitor (NAI) is associated with better outcome in patients hospitalized with influenza, but significant mortality occurs despite use of antivirals. N-acetylcysteine (NAC) is a modified form of the amino acid cysteine, with anti-oxidant properties. NAC was shown to inhibit the production of pro-inflammatory molecules in lung epithelial cells infected with influenza viruses. Previous case report showed that high dose NAC, administered as continuous intravenous infusion, was effective and safe in improving the clinical outcomes. We aim to perform a randomized controlled trial to evaluate the therapeutic role of adjunctive NAC in the clinical management of patients with influenza complicated by lower respiratory tract involvement and abnormal respiratory status. Such information when available may reveal the potential of NAC for optimization of management of severe influenza, and provide important insights into future adjunctive therapy research.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Chinese University of Hong Kong
• Treatments: Acetylcysteine; N-monoacetylcystine; Oseltamivir

Criteria

Inclusion Criteria:

• influenza A and B virus infections confirmed by polymerase chain reaction (PCR) and/or immunofluorescence assays,

• hospitalized for the management of severe manifestations of influenza,

• presenting within 5 days from illness onset,

• clinical evidence of lower respiratory tract infection (e.g. shortness of breath, tachypnea, oxygen desaturation <93% on room air, crepitations on auscultation, infiltrations or consolidations on chest radiograph)

• ability to provide written informed consent.

Exclusion Criteria:

• use of systemic corticosteroids (except for those who need low dose hydrocortisone 50mg qid for refractory septic shock)

• use of other immunosuppressants (e.g. post-chemotherapy, post-transplant, autoimmune diseases)

• known immuno-compromised conditions (e.g. active haematological malignancies, HIV/AIDS),

• pregnancy

• lactation,

• end-stage renal failure

• hepatic failure

• cardiac failure

• patients on anticoagulation,

• patients with scheduled major surgery within 2 weeks (NAC may affect blood clotting),

• patients who have received macrolide antibiotics and NSAID for 1 week prior to enrolment due to their immuno-modulating effects.