Chinese researchers reported the first ever clinically documented case of resistance to the antiviral medication Tamiflu in patients infected with the H7N9 bird flu.

In the case of 14 patients admitted to the Shanghai Public Health Clinical Center in April, treatment with antiviral medications helped in all but three. Those three developed severe illnesses that required the delivery of oxygen to the circulatory and respiratory systems with a machine, known as extracorporeal membrane oxygenation (ECMO). Two of the three died. A viral mutation associated with drug resistance was isolated in two of them.

One of the mutations appeared to arise in one of the patients with oxygen support as a result of treatment.

In a report of the cases, the researchers wrote: “The apparent ease with which antiviral resistance emerges … is concerning; it needs to be closely monitored and considered in future pandemic response plans.”

— Posted by Alexander Reed Kelly.

MedPage Today:

… the mutation appeared to be associated with a poor outcome: all of the 11 patients who did not need ECMO had wild-type virus, while two of the three who needed ECMO had the mutation.

One patient, who later died, had wild-type virus in a sample taken 2 days after starting oseltamivir, but had the mutation in samples taken 7 days after starting therapy — apparently as a result of the treatment.

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