Amantadine and rimantadine for influenza A in children and the elderly
Márcia G Alves Galvão1, Marilene Augusta Rocha Crispino Santos, Antonio J L Alves da Cunha
1Municipal Secretariat of Health, Avenida Ayrton Senna, 250/ 205, Barra da Tijuca. Alfa Barra 1, Rio de Janeiro, RJ, Brazil, 22793-000.
Insights
Amantadine showed effectiveness in preventing influenza A in children, but evidence quality was low. Rimantadine offered limited benefits for treating fever in children, with no prophylactic effect in the elderly. Safety data for amantadine was insufficient.
Area of Science:
- Virology
- Infectious Diseases
- Pharmacology
Background:
- Influenza A and B viruses cause acute respiratory illness.
- Complications of influenza are more common in children and the elderly.
Purpose of the Study:
- Assess amantadine and rimantadine effectiveness and safety.
- Evaluate prevention, treatment, and duration of influenza A in children and elderly.
Main Methods:
- Searched CENTRAL, MEDLINE, and EMBASE databases.
- Included randomized controlled trials (RCTs) and quasi-RCTs.
- Two authors independently assessed results and analyzed data using Cochrane methodology.
Main Results:
- Amantadine prevented influenza A in children (low-quality evidence).
- Rimantadine aided fever reduction in children (moderate-quality evidence).
- Rimantadine showed no prophylactic effect in the elderly (very low-quality evidence).
- No adverse effects were reported for either drug.
Conclusions:
- Limited benefits and low-quality evidence for amantadine and rimantadine.
- Insufficient safety data for amantadine.
- Current evidence does not support the use of these drugs for influenza A in children and the elderly.
Background:
Influenza is an acute respiratory illness caused by influenza A and B viruses. Complications may occur, especially among children and the elderly.
Objectives:
To assess the effectiveness and safety of amantadine and rimantadine in preventing, treating and shortening the duration of influenza A in children and the elderly.
Search Methods:
We searched CENTRAL (2014, Issue 9), MEDLINE (1966 to September week 4, 2014) and EMBASE (1980 to October 2014).
Selection Criteria:
Randomised controlled trials (RCTs) or quasi-RCTs comparing amantadine and/or rimantadine with no intervention, placebo, other antivirals or different doses or schedules of amantadine or rimantadine in children and the elderly with influenza A.
Data Collection And Analysis:
Two review authors independently assessed the search results. We extracted and analysed data using the standard Cochrane methodology.
Main Results:
We identified 12 studies (2494 participants: 1586 children and 908 elderly) comparing amantadine and rimantadine with placebo, paracetamol (one trial: 69 children) or zanamivir (two trials: 545 elderly) to treat influenza A.Amantadine was effective in preventing influenza A in children (773 participants, risk ratio (RR) 0.11; 95% confidence interval (CI) 0.04 to 0.30). The assumed risk of influenza A in the control group was 10 per 100. The corresponding risk in the rimantadine group was one per 100 (95% CI 0 to 3). Nevertheless, the quality of the evidence was low and the safety of the drug was not well established.For treatment, rimantadine was beneficial in abating fever on day three of treatment in children: one selected study with low risk of bias, moderate evidence quality and 69 participants (RR 0.36; 95% CI 0.14 to 0.91). The assumed risk was 38 per 100. The corresponding risk in the rimantadine group was 14 per 100 (95% CI 5 to 34).Rimantadine did not show any prophylactic effect in the elderly. The quality of evidence was very low: 103 participants (RR 0.45; 95% CI 0.14 to 1.41). The assumed risk was 17 per 100. The corresponding risk in the rimantadine group was 7 per 100 (95% CI 2 to 23).There was no evidence of adverse effects caused by treatment with amantadine or rimantadine.We found no studies assessing amantadine in the elderly.
Authors' Conclusions:
The quality of the evidence combined with a lack of knowledge about the safety of amantadine and the limited benefits of rimantadine, do not indicate that amantadine and rimantadine compared to control (placebo or paracetamol) could be useful in preventing, treating and shortening the duration of influenza A in children and the elderly.
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