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Children with influenza A infection: treatment with rimantadine
Insights
Rimantadine effectively reduced influenza symptoms in children but led to increased viral shedding and drug resistance. Acetaminophen did not show these effects, suggesting caution with rimantadine use.
Area of Science:
- Pediatric infectious diseases
- Virology
- Pharmacology
Background:
- Influenza treatment in children requires effective antiviral strategies.
- The development of antiviral resistance is a significant concern in clinical settings.
- Previous studies have not fully investigated rimantadine resistance in pediatric influenza isolates.
Purpose of the Study:
- To compare the efficacy of rimantadine and acetaminophen in treating influenza in children.
- To assess the development of rimantadine resistance in clinical influenza isolates during therapy.
Main Methods:
- A double-blind, controlled study involving 91 children with influenza-like illness.
- Comparison of rimantadine versus acetaminophen therapy over five days.
- Monitoring of clinical symptoms, viral shedding, and drug resistance through serial isolates.
Main Results:
- Rimantadine significantly reduced fever and improved symptoms in the initial three days compared to acetaminophen.
- Viral shedding increased in the rimantadine group after initial reduction, with higher viral loads by days 6-7.
- A significantly higher proportion of children on rimantadine developed resistant influenza A/H3N2 isolates (27%) compared to acetaminophen (6%).
Conclusions:
- Rimantadine demonstrates short-term clinical benefits for pediatric influenza but is associated with increased viral shedding and the emergence of drug resistance.
- The clinical significance of rimantadine resistance development requires further investigation.
- Acetaminophen serves as a comparable alternative without the associated risk of inducing antiviral resistance.
Abstract:
Treatment with rimantadine of influenza in children and the potential development of resistance in clinical isolates associated with therapy have not been previously studied. We compared rimantadine to acetaminophen therapy in a controlled, double-blind study of 91 children with influenza-like illness. Of 69 children with proven influenza A/H3N2 infection, 37 received rimantadine and 32 received acetaminophen for five days. Children receiving rimantadine showed significantly greater reduction in fever and improvement in daily scores for symptoms and severity of illness during the first three days. Viral shedding also diminished significantly during the first two days but subsequently increased such that by days 6 and 7 the proportion of children shedding virus, as well as the quantity of virus shed, was significantly greater in the rimantadine group. During the seven-day study, of the 22 children in the rimantadine group with serial isolates tested, ten (45.5%) had resistant isolates compared with two (12.5%) of those with serial isolates in the acetaminophen group (P less than .03). Thus, of the total 37 children in the rimantadine group, 27% were found to have resistant isolated compared with 6% in the total group receiving acetaminophen (P less than .04). Furthermore, the mean inhibitory concentration of rimantadine increased with time in the rimantadine group (r = .4, P = .002) but not in the acetaminophen group. Rimantadine therapy, thus, appears to be significantly more effective than acetaminophen in ameliorating the clinical signs and symptoms of influenza in children. Treatment with rimantadine was also associated with increased viral shedding after the medication was discontinued and with the development of resistance in the clinical isolates, the significance of which is unknown.