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Antivirals for pandemic influenza
1Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville 22908, USA.
The Journal of Infectious Diseases
|August 1, 1997
Summary
Amantadine and rimantadine show promise for pandemic influenza response due to their effectiveness and stockpiling potential. However, insufficient production capacity and concerns about drug resistance and side effects limit their widespread use.
Area of Science:
- Virology
- Pharmacology
- Public Health
Background:
- Amantadine and rimantadine possess characteristics suitable for pandemic influenza preparedness, including activity against influenza A viruses.
- Their favorable pharmacokinetics and documented efficacy in prophylaxis and therapy support their consideration for stockpiling.
Purpose of the Study:
- To evaluate the suitability of amantadine and rimantadine as agents for responding to pandemic influenza.
- To identify limitations and concerns associated with their use in large-scale scenarios.
Main Methods:
- Review of existing literature on amantadine and rimantadine.
- Analysis of production capabilities, pharmacokinetic profiles, and clinical effectiveness data.
- Assessment of safety profiles, including adverse effects and drug interactions.
- Evaluation of viral resistance patterns and transmissibility.
Main Results:
- Current production levels are inadequate for mass chemoprophylaxis during pandemics, especially if vaccines are unavailable.
- Adverse drug effects, particularly central nervous system issues with amantadine, and potential drug interactions are significant concerns.
- Emergence of drug-resistant influenza A viruses during therapy is a documented issue, with these resistant strains remaining pathogenic and transmissible.
Conclusions:
- While amantadine and rimantadine offer potential benefits for pandemic influenza, limitations in production, safety concerns, and the emergence of drug resistance necessitate careful consideration.
- Investigational neuraminidase inhibitors present an alternative, but further research is needed regarding their prophylactic efficacy, cost-effectiveness, administration, and resistance profiles.