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Oseltamivir-resistant pandemic (H1N1) 2009 influenza in a severely ill patient: the first Australian case

David J Speers, Simon H Williams, Mary Pinder, Harry R Moody, Aeron C Hurt and David W Smith
Med J Aust 2010; 192 (3): . || doi: 10.5694/j.1326-5377.2010.tb03459.x
Published online: 1 February 2010

After a 10-day course of oral oseltamivir for pandemic (H1N1) 2009 influenza infection, a renal transplant recipient developed rapid-onset severe primary viral pneumonia due to oseltamivir-resistant virus. Respiratory failure progressed despite high-dose oral oseltamivir, nebulised zanamivir and cessation of immunosuppressive medications, but his condition improved with intravenous zanamivir. He subsequently died of non-respiratory complications. This is the first case of oseltamivir-resistant pandemic (H1N1) 2009 in Australia and the first report of resistance in a solid organ transplant recipient. (MJA 2010; 192: 166-168)

A 38-year-old cadaveric renal transplant recipient had remained well on a standard immunosuppressive regimen until he presented 7 weeks after transplantation with coryzal symptoms and fever. Nose and throat swabs were collected for influenza testing, and he was empirically commenced on oral oseltamivir at the recommended dose of 75 mg twice a day,1,2 to be taken at home. The swabs were subsequently confirmed as positive for pandemic (H1N1) 2009 influenza (Box), and he continued taking oseltamivir for 10 days, with clinical improvement.


  • 1 Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA, Perth, WA.
  • 2 Sir Charles Gairdner Hospital, Perth, WA.
  • 3 WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, VIC.
  • 4 School of Biomedical, Biomolecular and Chemical Sciences and School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA.



Acknowledgements: 

We wish to acknowledge Ms Glenys Chidlow for her help in developing the methods for oseltamivir-resistance molecular testing, Yi Deng for performing the pyrosequencing, and Ms Kerry Benson for assisting with collecting patient information.

Competing interests:

David Smith sits on two advisory committees that receive sponsorship from Roche Pharmaceuticals.

  • 1. Robson R, Buttimore A, Lynn K, et al. The pharmacokinetics and tolerability of oseltamivir suspension in patients on haemodialysis and continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 2006; 21: 2556-2562.
  • 2. Karie S, Launay-Vacher V, Janus N, et al. Pharmacokinetics and dosage adjustment of oseltamivir and zanamivir in patients with renal failure. Nephrol Dial Transplant 2006; 21: 3606-3608.
  • 3. Taylor WRJ, Thinh BN, Anh GT, et al. Oseltamivir is adequately absorbed following nasogastric administration to adult patients with severe H5N1 influenza. PLoS One 2008; 3: e3410.
  • 4. Hurt AC, Holien JK, Barr IG. In vitro generation of neuraminidase inhibitor resistance in A(H5N1) influenza viruses. Antimicrob Agents Chemother 2009; 53: 4433-4440.
  • 5. Moscona A. Global transmission of oseltamivir-resistant influenza. N Engl J Med 2009; 360: 953-956.
  • 6. Hurt AC, Ernest J, Deng YM, et al. Emergence and spread of oseltamivir-resistant A(H1N1) influenza viruses in Oceania, South East Asia and South Africa. Antiviral Res 2009; 83: 90-93.
  • 7. World Health Organization. Global Alert and Response. Pandemic (H1N1) 2009 – update 69. 9 Oct 2009. http://www.who.int/csr/don/2009_10_09/en/index.html (accessed Dec 2009).
  • 8. Leung TW, Tai AL, Cheng PK, et al. Detection of an oseltamivir-resistant pandemic influenza A/H1N1 virus in Hong Kong. J Clin Virol 2009; 46: 298-299.
  • 9. Centers for Disease Control and Prevention (CDC). Oseltamivir-resistant novel influenza A (H1N1) virus infection in two immunosuppressed patients – Seattle, Washington, 2009. MMWR Morb Mortal Wkly Rep 2009; 58: 893-896.

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