USE OF AMANTADINE IN THE NURSING HOME

美国疾病控制中心推荐金刚烷胺用于控制 疗养院甲型流感疫情的爆发是对工作人员和 在流感期间发生疫情时的所有居民 这项建议令人不安。 因为：1)关于其在养老院暴发中的疗效的数据有限； 2)缺乏能够证明这种能力的对照前瞻性研究 金刚烷胺在减少流感及其并发症护理中的应用 居家环境；3)与使用金刚烷胺有关的毒性 长者；4)具抗药性的病毒在 金刚烷胺的存在；5)“社区”和“社区”的歧义 因此，建议的预防持续时间。 我们实验室的重点一直是年龄对疫苗的影响。 老年人的反应、流感易感性和药物毒性 并导致我们目前对金刚烷胺预防和治疗的兴趣 治疗。我们最近展示了它的出现和传播 金刚烷胺耐药甲型流感病毒和更严重的金刚烷胺 相关毒性比疗养院之前认为的要高 布景。 假设金刚烷胺是预防的(区别于金刚烷胺 治疗)在疗养院可以有效地限制流感 对于甲型H1N1流感的爆发，我们假设：1)甲型流感病例将减少 在疗养院的地板上，临床上的流感病例都是用 金刚烷胺在治疗期间被移出家门； 2)金刚烷胺，用于限制护理中的流感爆发 居家环境，将以更短的持续时间减少毒性 预防；3)金刚烷胺耐药流感病毒株的出现将 发生与血清金刚烷胺水平无关；以及，4)持续时间 金刚烷胺的预防应以甲型流感病毒在 养老院，而不是整个社区。 拟议的5年研究将涉及大多数居住在此的受试者。 在一家有685个床位的乡村疗养院。我们将通过以下方式记录疫苗反应 测量流感抗体效价，监测受试者以识别 呼吸道疾病和流感感染，一旦流感 确诊后，通过处方治疗计划进行干预 包括呼吸隔离和金刚烷胺给药。我们会 还可确定金刚烷胺的临床毒性、金刚烷胺水平，以及 金刚烷胺耐药流感的特征与金刚烷胺的比较 水平和相关疾病。在此结束时 前瞻性的临床试验，我们将为未来奠定良好的基础 关于在疗养院使用金刚烷胺的建议 农村和城市地区的流感季节将包括 将毒性降至最低的策略。

The Centers for Disease Control recommendation for amantadine to control nursing home influenza A outbreaks is "rapid administration to staff and all residents when outbreaks occur for the duration of influenza activity in the community". This recommendation is disconcerting because: 1) of limited data of its efficacy in nursing home outbreaks; 2) absence of controlled prospective studies demonstrating the ability of amantadine to reduce influenza or its complications in the nursing home setting; 3) of the toxicity associated with amantadine use in the elderly; 4) of the potential transmission of resistant viruses in the presence of amantadine; and 5) the ambiguity of 'community' and therefore the recommended duration of prophylaxis. Our laboratory focus has been on the effect of age upon vaccine response, influenza susceptibility, and drug toxicity in elderly people and has led to our current interest in amantadine prophylaxis and treatment. We recently demonstrated the emergence and transmission of amantadine resistant iffluenza A viruses and more severe amantadine associated toxicity than previously believed in the nursing home setting. Assuming that amantadine prophylaxis (in distinction to amantadine treatment) in the nursing home can effectively limit influenza outbreaks, we hypothesize that: 1) fewer cases of influenza A will arise on nursing home floors where clinical cases of influenza treated with amantadine are removed from the home for the duration of their treanmnt; 2) amantadine, when used to limit influenza outbreaks in the nursing home setting, will have reduced toxicity with a shorter duration of prophylaxis; 3) emergence of amantadine resistant influenza strains will occur independent of the serum amantadine level; and, 4) duration of amantadine prophylaxis should be based on presence of influenza A within the nursing home, and not the community at large. The proposed 5 year study will involve the majority of subjects residing at a 685 bed rural nursing home. We will document vaccine response by measuring influenza antibody titers, monitor subjects to identify respiratory illnesses and influenza infections, and once influenza is diagnosed, intervene with a prescribed treatment program that will involve irspiratory isolation and amantadine administration. We will also determine clinical amantadine toxicity, amantadine levels, and characterize amantadine resistant influenza as compare with amantadine levels and the associated illness. At the conclusion of this prospective clinical trial, we will have a sound basis for future recommendations regarding the use of amantadine in nursing homes during the influenza season for both rural and urban settings that will include strategies to minimize toxicity.