Drug-resistant avian influenza A (H5N1) viral infection is no longer just a theoretical prediction — it is a reality, with the recent report of a case of resistance to oseltamivir (Tamiflu).1 A 13-year-old Vietnamese girl died 7 days after being admitted and treated for influenza A (H5N1) virus infection, despite receiving early, therapeutic doses of oseltamivir. She deteriorated from Day 4 after admission, suggesting that drug resistance developed during treatment. The case report authors said that new treatment strategies such as using higher doses and longer durations of antiviral therapy or combination therapy may deserve further evaluation. An accompanying editorial said that, in light of this frightening report, improper use of personal stockpiles of oseltamivir, which may promote resistance, should be strongly discouraged.2
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