先講美國疾管局的建議.
使用抗病毒藥物治療流感效果最佳，最好在流感症狀出現後 1-2 天內開始服用。
抗病毒藥物可以減輕症狀，並將病程縮短約一天。
在症狀出現後儘快開始抗病毒治療還有幫助減少一些流感併發症。
一些研究表明，對於因流感住院的成年患者，早期抗病毒治療可以縮短住院時間並降低死亡風險。
回到這篇主題. 結果與CDC過去建議相反.
CDC-Treating Flu with Antiviral Drugs-June 26, 2026
Treatment of flu with flu antiviral medications works best when started within 1-2 days after flu symptoms begin. Flu antiviral drugs can lessen symptoms and shorten the time you are sick by about a day. Starting antiviral treatment shortly after symptoms begin also can help reduce some flu complications. For adults hospitalized with flu, some studies have reported that early antiviral treatment can reduce the duration of hospitalization and their risk of death.
Treatment of flu with flu antiviral medications works best when started within 1-2 days after flu symptoms begin. Flu antiviral drugs can lessen symptoms and shorten the time you are sick by about a day. Starting antiviral treatment shortly after symptoms begin also can help reduce some flu complications. For adults hospitalized with flu, some studies have reported that early antiviral treatment can reduce the duration of hospitalization and their risk of death.
流感重症使用抗病毒藥物, 死亡率會上升 .
但這僅是一篇研究. 尚無法推翻過去對於流感重症的治療建議
整理一下.
442例流感重症
162名使用 oseltamivir 治療5天 32例死亡, 死亡率 19.8%
156名使用 oseltamivir 治療10天 30例死亡, 死亡率 19.4%
124名 未接受抗病毒藥物治療 17例死亡. 死亡率 13.7%
(下面中文用google翻譯)
背景：抗病毒藥物奧司他韋廣泛用於治療流感重症患者。然而，目前尚缺乏隨機對照試驗證據來證實其對重症患者的療效。
方法：在一項正在進行的國際多因子貝葉斯自適應平台隨機對照試驗中，我們評估了奧司他韋治療5天、奧司他韋治療10天或不接受抗病毒治療對12歲及以上確診流感重症呼吸道感染重症患者的療效。主要終點為90天死亡率。比值比小於1表示奧司他韋治療有益。
結果：2020年3月1日至2026年3月13日期間，共有442名受試者被隨機分配接受奧司他韋治療5天（n=162）、奧司他韋治療10天（n=156）或不接受抗病毒治療（n=124）。在一次預定的適應性分析中，兩種奧司他韋療程均達到了預設的劣效性閾值（在流感抗病毒領域成為最佳治療方案的機率<0.2%），因此停止了招募。到第90天，未接受抗病毒治療組有17例（13.7%）死亡，5天奧司他韋組有32例（19.8%）死亡，10天奧司他韋組有30例（19.4%）死亡。 90天死亡率的中位調整後OR值，5天奧司他韋組為2.13（95% CrI 1.03至4.52），10天奧司他韋組為2.17（95% CrI 1.05至4.64），結果顯示未接受抗病毒治療組的風險較低。對於5天和10天的奧司他韋治療，其不良反應的後驗機率（調整後的OR值>1）分別為98.0%和98.2%。
結論：奧司他韋治療無效，且極有可能增加重症流感患者的90天死亡率。
Oseltamivir for Critically Ill Patients with Influenza: A Randomised Trial
29 Pages Posted: 27 Jul 2026
Srinivas Murthy
University of British Columbia (UBC)
Cameron Green
Monash University
Lindsay Berry
Berry Consultants, LLC
Please see PDF for full list of authors & affiliations
More...
Abstract
Background: The antiviral oseltamivir is widely used for the treatment of critically ill patients with influenza. Evidence from randomised trials about its efficacy in the critically ill is lacking.
Methods: In an ongoing international, multifactorial, Bayesian adaptive platform randomised trial, we evaluated oseltamivir for 5 days, oseltamivir for 10 days, or no antiviral treatment in critically ill patients aged 12 years and older with confirmed influenza severe respiratory infection. The primary outcome was 90-day mortality. An odds ratio less than 1 indicates benefit from oseltamivir.
Findings: Between March 1, 2020 and March 13, 2026, 442 participants were randomised to receive 5 days of oseltamivir (n=162), 10 days of oseltamivir (n=156), or no antiviral (n=124). At a scheduled adaptive analysis, both oseltamivir durations met a predefined inferiority threshold (<0·2% probability of being the best treatment in the influenza antiviral domain), triggering cessation of recruitment. By day 90, 17 (13·7%) in the no antiviral group, 32 (19·8%) in the 5-day oseltamivir group, and 30 (19·4%) in the 10-day oseltamivir group had died. The median adjusted OR for 90-day mortality was 2·13 (95% CrI 1·03 to 4·52) for 5 days of oseltamivir and 2·17 (95% CrI 1·05 to 4·64) for 10 days of oseltamivir, favouring no antiviral. For the 5- and 10-day oseltamivir treatments, the posterior probabilities for harm, an adjusted OR >1, were 98·0% and 98·2%, respectively.
Interpretation: Treatment with oseltamivir is ineffective and highly likely to increase 90-day mortality in critically ill patients with influenza.
29 Pages Posted: 27 Jul 2026
Srinivas Murthy
University of British Columbia (UBC)
Cameron Green
Monash University
Lindsay Berry
Berry Consultants, LLC
Please see PDF for full list of authors & affiliations
More...
Abstract
Background: The antiviral oseltamivir is widely used for the treatment of critically ill patients with influenza. Evidence from randomised trials about its efficacy in the critically ill is lacking.
Methods: In an ongoing international, multifactorial, Bayesian adaptive platform randomised trial, we evaluated oseltamivir for 5 days, oseltamivir for 10 days, or no antiviral treatment in critically ill patients aged 12 years and older with confirmed influenza severe respiratory infection. The primary outcome was 90-day mortality. An odds ratio less than 1 indicates benefit from oseltamivir.
Findings: Between March 1, 2020 and March 13, 2026, 442 participants were randomised to receive 5 days of oseltamivir (n=162), 10 days of oseltamivir (n=156), or no antiviral (n=124). At a scheduled adaptive analysis, both oseltamivir durations met a predefined inferiority threshold (<0·2% probability of being the best treatment in the influenza antiviral domain), triggering cessation of recruitment. By day 90, 17 (13·7%) in the no antiviral group, 32 (19·8%) in the 5-day oseltamivir group, and 30 (19·4%) in the 10-day oseltamivir group had died. The median adjusted OR for 90-day mortality was 2·13 (95% CrI 1·03 to 4·52) for 5 days of oseltamivir and 2·17 (95% CrI 1·05 to 4·64) for 10 days of oseltamivir, favouring no antiviral. For the 5- and 10-day oseltamivir treatments, the posterior probabilities for harm, an adjusted OR >1, were 98·0% and 98·2%, respectively.
Interpretation: Treatment with oseltamivir is ineffective and highly likely to increase 90-day mortality in critically ill patients with influenza.
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