Neuraminidase inhibitors for preventing and treating influenza in children
Insights
Neuraminidase inhibitors like oseltamivir and zanamivir shorten influenza illness in healthy children. Efficacy in at-risk children needs more proof, but oseltamivir also reduces complications.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Pharmacology
Background:
- Influenza attack rates in children can exceed 40% during epidemic years.
- Neuraminidase inhibitors, including zanamivir and oseltamivir, are key options for influenza prevention and treatment.
- Assessing their role in pediatric influenza is crucial for public health.
Purpose of the Study:
- To evaluate the efficacy, safety, and tolerability of neuraminidase inhibitors for treating and preventing influenza in children.
- To synthesize evidence from randomized controlled trials and other relevant data sources.
Main Methods:
- Comprehensive literature search of multiple databases (Cochrane, MEDLINE, EMBASE) and clinical trial registries.
- Inclusion of double-blind, randomized, controlled trials in children under 12 years comparing neuraminidase inhibitors to placebo or other antivirals.
- Data extraction and analysis performed separately for oseltamivir and zanamivir, with quality assessment of included studies.
Main Results:
- Oseltamivir and zanamivir significantly reduced illness duration by 24-26% in healthy children with confirmed influenza.
- Oseltamivir demonstrated a significant reduction in influenza complications, particularly otitis media.
- Oseltamivir showed a trend towards efficacy in preventing influenza transmission within households, though not statistically significant.
- Vomiting was a more common adverse event with oseltamivir compared to placebo.
Conclusions:
- Neuraminidase inhibitors effectively shorten influenza illness duration in healthy pediatric populations.
- Further research is needed to establish the efficacy of these inhibitors in 'at-risk' children.
- Oseltamivir shows promise in reducing secondary influenza complications and may be beneficial for prophylaxis.
Background:
During epidemic years, influenza attack rates in children exceed 40%. Options for prevention and treatment include the neuraminidase inhibitors: zanamivir and oseltamivir.
Objectives:
To assess the efficacy, safety and tolerability of neuraminidase inhibitors in the treatment and prevention of influenza infection in children.
Search Strategy:
We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005); MEDLINE (1966 to April 2005); EMBASE (January 1980 to December 2004); the on-line GlaxoSmithKline Clinical Trials Register; the on-line Roche Clinical Trial Protocol Registry and Clinical Trial Results Database (August 2005); and reference lists of articles. We also scrutinised web sites of European and US regulatory bodies and contacted manufacturers and authors.
Selection Criteria:
Double-blind, randomised, controlled trials comparing neuraminidase inhibitors with placebo or other antiviral drugs in children less than 12 years of age. Additional safety and tolerability data from other sources were also included.
Data Collection And Analysis:
Four authors applied the inclusion criteria to the retrieved studies, assessed trial quality and extracted data. Data were analysed separately for oseltamivir and zanamivir.
Main Results:
Three trials involving 1500 children with a clinical case definition of influenza were included, of whom 977 had laboratory-confirmed influenza. Overall, trial quality was good. Oseltamivir reduced the median duration of illness by 26% (36 hours) in healthy children with laboratory-confirmed influenza (P value less than 0.0001). The reduction was only 7.7% (10 hours) in 'at risk' (asthmatic) children, and this did not reach statistical significance (P value = 0.54). Zanamivir reduced the median duration of illness by 24% (1.25 days) in healthy children with laboratory-confirmed influenza (P value less than 0.001). No data in 'at risk' children were available. Only oseltamivir produced a significant reduction in the complications of influenza (particularly otitis media), although there was a trend to benefit for zanamivir. We identified one randomised, controlled trial of oseltamivir for the prevention of influenza transmission in households, reporting data from 222 paediatric contacts. Where index cases had laboratory-confirmed influenza, a protective efficacy of 55% was observed, but this did not reach statistical significance (P value = 0.089). The adverse events profile of zanamivir was no worse than placebo, but vomiting was more common in children treated with oseltamivir.
Authors' Conclusions:
Neuraminidase inhibitors are effective in shortening illness duration in healthy children with influenza, but efficacy in 'at risk' children remains to be proven. Oseltamivir is also effective in reducing the incidence of secondary complications, and may be effective for influenza prophylaxis.
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