Neuraminidase inhibitors: who, when, where?
J S Nguyen-Van-Tam1, S Venkatesan1, S G Muthuri1
1Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham School of Medicine, City Hospital Campus, Nottingham, UK.
Summary
Neuraminidase inhibitors (NIs) offer modest symptom relief for influenza but significantly reduce complications and hospitalizations in adults. Their effectiveness in children remains unclear, suggesting NIs should be reserved for high-risk or severely ill patients.
Area of Science:
- Virology
- Infectious Diseases
- Pharmacology
Background:
- Neuraminidase inhibitors (NIs), including oseltamivir and zanamivir, were approved in 1999.
- Debate continues regarding the clinical effectiveness of NIs for influenza treatment.
Purpose of the Study:
- To evaluate the clinical effectiveness of neuraminidase inhibitors (NIs) for influenza.
- To determine the impact of NIs on symptom duration, complications, hospitalizations, and mortality in different patient populations.
Main Methods:
- Systematic reviews and meta-analyses of clinical trial data from community settings.
- Meta-analysis of observational data from the 2009 influenza A(H1N1) pandemic.
Main Results:
- NIs provide very modest reductions in influenza symptom duration (less than one day).
- Recent reviews show NIs significantly reduce antibiotic use (44%) and hospitalizations (63%) in adults.
- Meta-analysis indicates NIs reduced mortality by 25% in hospitalized adults, and 62% if initiated within 48 hours.
- NI effectiveness in children is less clear.
Conclusions:
- NIs demonstrate significant benefits in reducing complications and mortality, particularly in hospitalized adults.
- The effectiveness of NIs in pediatric influenza cases requires further investigation.
- NIs should be prioritized for high-risk individuals, severely ill patients, or those rapidly deteriorating, with prompt empirical treatment recommended.
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