Pandemic influenza: is an antiviral response realistic?

Antiviral agents could play a significant role in the response to a future influenza pandemic, especially if an effective vaccine is unavailable. There is, however, a limited availability of antiviral drugs, as was the case during the A/Fujian(H3N2) epidemic in the 2003-2004 season. There are major differences among the available antiviral agents in terms of clinical pharmacology, adverse effects and resistance profiles, all of which must be considered when selecting agents for pandemic use and stockpiling. The logistic issues involved in delivering the drug to large populations must also be considered. The M2 ion channel inhibitors amantadine and rimantadine are partially effective for chemoprophylaxis of pandemic influenza, and when used for early treatment they provide some symptom relief. Interpandemic studies demonstrate that the neuraminidase inhibitors would be effective for both prevention and treatment of influenza.

Given the limited supply and the previously demonstrated inability of the manufacturing sector to meet surging needs, an effective antiviral response could not currently be launched in the United States. Antiviral agents could be important in managing and treating pandemic influenza and reduce lower respiratory complications and hospitalizations.