口服電解質補充液配方- WHO世界衛生組織版-簡易版

2026-08-27
這個本來貼在筆記-野外與登山醫學-2025年野外燒燙傷處置臨床指引
另外貼出來. 方便以後查詢

圖片左邊是WHO建議配方. 右邊是WMS簡易配方. 
WMS 指引-英文原文 Table 1. Recipes for oral rehydration solution.

世界衛生組織配方

1公升清水
6茶匙糖
3/8 茶匙鹽
¼ 茶匙代鹽（氯化鉀）
½ 茶匙小蘇打

流感-美國疾管局建議 CDC

2026-08-27 17:01

剛看到急診醫師社團貼文. 使用克流感無法降低流感重症死亡率. 反而可能增加90天內死亡率. 重新查一下美國疾管局的資訊

我之前的印象(CDC也是這樣說)

1. 病情較輕不屬於流感重症高風險族群. 大多數不需要使用抗病毒藥物治療

2. 輕症患者使用 Oseltamivir (克流感 Tamiflu 成分) 的好處, 可減輕50%症狀嚴重度. 可縮短病程 0.5~ 1 天 (CDC寫1天) 

Oseltamivir 是羅氏藥廠開發的藥物. 過去的數據是針對健康成人罹患流感之後使用 Oseltamivir 治療. 這組人的平均生病時間 3.6 天. 所謂 48 小時內給藥. 並不是超過 48 小時之後無效. 而是48小時之後, 有吃抗病毒藥物的也痊癒了. 沒吃抗病毒藥物的也痊癒了. 因為大家都好了. 所以吃不吃藥沒差別. 

順便貼上台灣疾管署的資訊

流感

在台灣，約0.5%的門診流感病例需要住院治療。在因嚴重併發症住院的患者中，約7%需要重症監護，此族群的死亡率約為20%。

下面是美國疾管局的資料
CDC-Treating Flu with Antiviral Drugs
For Everyone June 26, 2026

先節錄一小段. 英文全文貼最下面

哪些人應該服用抗病毒藥物

對於下列情況的流感患者，儘早開始使用流感抗病毒藥物治療至關重要：

1. 因流感住院
2. 那些患有流感病情嚴重但無需住院治療的人，

3. 高風險慢性疾病

4. 孕婦

雖然病情較輕且不屬於流感併發症高風險族群的患者也可以接受抗病毒藥物治療，但大多數患者並不需要接受治療。

At a glance

• Flu antiviral drugs are prescription medicines that can be used to treat flu illness.
• They can lessen symptoms and shorten the time you are sick.
• Antiviral drugs work best when started within 1 to 2 days after flu symptoms begin.
• CDC recommends prompt treatment for people who have flu or suspected flu and who are at increased risk of serious flu complications, such as pregnant women, people with asthma and chronic lung disease, diabetes (including gestational diabetes), or heart disease.

Treatment overview

Flu antiviral drugs are prescription medicines (pills, liquid, an inhaled powder, or an intravenous solution) that fight against flu viruses in your body. Antiviral drugs are not sold over the counter. You can only get them if you have a prescription from a health care provider. Antiviral drugs are different from antibiotics, which fight against bacterial infections. Antiviral drugs for flu only work to treat flu. Flu antiviral drugs are different than antiviral drugs used to treat other infectious diseases such as COVID-19. Antiviral drugs prescribed to treat COVID-19 are not approved or recommended to treat flu.

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.

Recommended antiviral drugs for this flu season

There are four FDA-approved antiviral drugs recommended by CDC to treat flu this season.

• oseltamivir phosphate (available as a generic version or under the trade name Tamiflu®),
• zanamivir (trade name Relenza®),
• peramivir (trade name Rapivab®), and
• baloxavir marboxil (trade name Xofluza®).

Oseltamivir

Generic oseltamivir and Tamiflu® are available as a pill or liquid suspension and are FDA approved for early treatment of flu in people 14 days and older.

Zanamivir

Zanamivir is a powdered medication that is inhaled and approved for early treatment of flu in people 7 years and older. Note: Zanamivir (trade name Relenza®) is administered using an inhaler device and is not recommended for people with breathing problems like asthma or COPD. Oseltamivir and zanamivir are given twice a day for five days.

Peramivir

Peramivir is given once intravenously by a health care provider and is approved for early treatment of flu in people 6 months and older.

Baloxavir

Baloxavir is a pill given as a single dose by mouth and is approved for early treatment of uncomplicated flu in people 5 years and older. Baloxavir is also approved for post-exposure prophylaxis (use in preventing flu) in people 5 years and older following contact with a person with flu. Note: Baloxavir (trade name Xofluza®) is not recommended for treatment of flu during pregnancy or while breastfeeding, or in outpatients with complicated or progressive illness because there is no information about use of baloxavir in these patients. Baloxavir is also not recommended for treatment of flu in hospitalized patients due to limited data.

Who should take antiviral drugs

It's very important that flu antiviral drugs are started as soon as possible to treat patients who are:

• hospitalized with flu,
• people who are very sick with flu but who do not need to be hospitalized, and
• people who are at increased risk of serious flu complications based on their age or underling health conditions, if they develop flu symptoms. For example, people with asthma and chronic lung disease, diabetes, or heart disease are at higher risk, as well as pregnant women.

Although patients with mild illness who are not at higher risk for flu complications may also be treated with antiviral drugs, most do not need to be.

Keep ReadingPeople at Increased Risk for Flu Complications

Children

Children and flu antiviral drugs

Parents, if your child gets sick with flu, antiviral drugs offer a safe and effective treatment option. For treatment, flu antiviral drugs should ideally be started within two days after becoming sick and taken according to your doctor's instructions (usually for five days).

Children can take flu antiviral drugs, though this varies by medication. Oseltamivir is recommended by CDC for treatment of flu in children beginning from birth and the American Academy of Pediatrics (AAP) recommends oseltamivir for treatment of flu in children 2 weeks old or older.

• Oseltamivir is available as an oral suspension for children.
• Zanamivir is approved for early treatment of flu in people 7 years and older, though it is not recommended for use in children with underlying respiratory disease, including asthma and other chronic lung diseases.
• Peramivir is approved for early treatment in people 6 months and older.
• Baloxavir is available in a single dose tablet for children 5 years and older.

If your child's health care provider prescribes oseltamivir capsules for your child and your child cannot swallow capsules, but the pediatric liquid suspension is not available, the prescribed capsules may be opened, mixed with a thick sweetened liquid, and given that way.

Keep ReadingOpening and Mixing Oseltamivir Capsules with Liquids if Child Cannot Swallow Capsules

Pregnancy

Oral oseltamivir is recommended for treatment of flu during pregnancy because compared to other recommended antiviral medications, it has the most studies available to suggest that it is safe and beneficial during pregnancy. Baloxavir is not recommended during pregnancy or while breastfeeding, as there are no available efficacy or safety data.

When antiviral drugs should be taken

Antiviral treatment provides the greatest benefit when started soon after flu illness begins. Studies show that flu antiviral drugs work best for treatment when they are started within two days of getting sick. However, starting them later can still be beneficial, especially if the sick person is at higher risk of serious flu complications or is in the hospital with more severe illness. Follow instructions for taking these drugs. Follow your doctor's instructions and the dose, frequency, and duration listed on the label instructions for taking these drugs.

How to get treatment

Check with your doctor promptly if you are at higher risk of serious flu complications (full list of people who are at higher risk) and you develop flu symptoms.

Keep ReadingSigns and Symptoms of Flu

What not to do

Antibiotics will not treat flu

When antibiotics aren't needed, they won't help you, and their side effects could still cause harm. Side effects can range from mild reactions, like a rash, to more serious health problems. These problems can include severe allergic reactions, antimicrobial-resistant infections and C. diff infection. C. diff causes diarrhea that can lead to severe colon damage and death.

Keep ReadingHealthy Habits: Antibiotic Do's and Don'ts

Possible side effects

Possible side effects vary for each flu antiviral medication. The most common side effects reported for oseltamivir are nausea and vomiting. Zanamivir can cause bronchospasm (difficulty breathing with wheezing), and peramivir can cause diarrhea. Other less common side effects also have been reported. Your health care provider can give you more information about these drugs or you can check the Food and Drug Administration (FDA) website for specific information about antiviral drugs, including the manufacturer's package insert.

Prevention

Antiviral drugs are not a substitute for getting a flu vaccine. While flu vaccine can vary in effectiveness from season-to-season, a flu vaccine is best way to help prevent seasonal flu and its potentially serious complications. Everyone 6 months and older should receive a flu vaccine every year. Antiviral drugs are a second line of defense that can be used to treat flu (including seasonal flu and novel influenza viruses) if you get sick.

流感重症患者使用"克流感"oseltamivir 無效-且90天內死亡率上升

2026-08-27 16:38
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。

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.

回到這篇主題. 結果與CDC過去建議相反. 

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

Oseltamivir for Critically Ill Patients with Influenza: A Randomised Trial 27 Jul 2026

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.