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Oseltamivir as a cause of acute enterorrhagia.

Dear Editor,

Oseltamivir, a neuraminidase inhibitor, plays a key role in the management of influenza. The most commonly reported adverse effect of oseltamivir is gastrointestinal discomfort including nausea and vomiting. (1,2) Here we report a case of enterorrhagia, a rare and neglected adverse effect after oseltamivir use.

A twelve year old boy was at day four of empiric treatment for Influenza infection and began to experience hematochezia. His mother brings him to the Emergency Department reporting four episodes of anal bleeding. Physical examination was normal and there were no signs of hemodynamic commitment. Laboratorial screening was performed and no abnormalities were seen. Hematocrit was 43.1%, hemoglobin 14.8 g/dL (NR: 13.5-17.5 g/dL), platelets 175,000 (NR: 150,000-450,000), RNI 1.14 and creatinine 0.84 (NR: 0.5-1.5). The child had no prior history of diseases, surgery or medication use and had a proper development to his age. The treatment was suspended, hematochezia ceded and the patient was full recovered.

Brazil is experimenting a rise in the incidence of influenza cases. In 2015, 30% of flu syndromes were caused by influenza virus with 1.8% of influenza A(H1N1)pdm09. This year however, influenza virus is responsible for 78.5% of flu syndrome and influenza A(H1N1)pdm09 for 70.9% of them. (3,4) This data makes the clinician alert to the problem and prompt to prescribe oseltamivir when facing a flu syndrome.

We are aware of controversial on the literature about the efficacy of oseltamivir. (5) In a developing country scenario, confirmatory tests for H1N1 are not available everywhere. The clinician must be aware of adverse events and consider the risk-benefit of treatment before prescription.

Received 12 July 2016

Accepted 24 July 2016

Available online 16 August 2016

Conflicts of interest

The authors declare no conflicts of interest.


(1.) Nakagawa Y, Nagai T, Okawara H, et al. Acute hemorrhagic colitis induced by the oral administration of oseltamivir used for influenza A treatment. Endoscopy. 2011;43:E261.

(2.) Yu HC, Huang JL. Acute hemorrhagic colitis after oral administration of oseltamivir for Influenza. Gastrointest Endosc. 2013;6:976.

(3.) Ministerio da Saude. Influenza: Monitoramento ate a Semana Epidemiologica 18 de 2015. Brasilia, DF: Secretaria de Vigilancia em Saude; 2015.

(4.) Ministerio da Saude. Influenza: Monitoramento ate a Semana Epidemiologica 18 de 2016. Brasilia, DF: Secretari de Vigilancia em Saude; 2016.

(5.) Dobson J, Whitley R, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomized controlled trials. Lancet. 2015;385:1729-37.

Francisco Beraldi-Magalhaes (a) *, Vera Batista (b), Marcelo Cordeiro-Santos (a)

(a) Universidade do Estado do Amazonas, Fundacao de Medicina Tropical Doutor Heitor Vieira Dourado, Programa de Pos-Graduacao em Medicinal Tropical, Manaus, AM, Brazil

(b) Hospital Universitario Getulio Vargas, Departmento de Pediatria, Manaus, AM, Brazil

* Corresponding author.

E-mail address: (F. Beraldi-Magalhaes).

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Author:Beraldi-Magalhaes, Francisco; Batista, Vera; Cordeiro-Santos, Marcelo
Publication:The Brazilian Journal of Infectious Diseases
Article Type:Letter to the editor
Date:Sep 1, 2016
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