Antiviral treatment for influenza infection in people with cystic fibrosis

Cystic fibrosis is a genetic, life-threatening disorder affecting multiple organs. People with cystic fibrosis have a higher risk of chronic lung disease. Influenza can worsen the course of the disease in cystic fibrosis by increasing the risk of pneumonia and secondary respiratory complications. During a pandemic, flu symptoms may be more severe and complications more frequent. Severe cases of pandemic flu have occurred in people with underlying chronic conditions including people with CF. Although there is no evidence that people with CF are more likely to contract this infection than healthy people, the impact for them could be greater and the outcome worse as the lower respiratory tract is affected more often. Antiviral agents form an important part of influenza management and include the neuraminidase inhibitors zanamivir and oseltamivir. These drugs can limit the infection and prevent the spread of the virus. We did not find any trials to support or refute the use of neuraminidase inhibitors for influenza in people with cystic fibrosis. However, limited data from previous studies have shown that these drugs can be effective in healthy people and may be useful in high-risk populations if used rationally. However, the question of the safety and effectiveness of neuraminidase inhibitors for treating influenza in people with cystic fibrosis remains unanswered.

Authors' conclusions: 

We were unable to identify any randomised controlled trials or quasi-randomised controlled trials on the efficacy of neuraminidase inhibitors for the treatment of influenza infection in people with cystic fibrosis. The absence of high level evidence for the effectiveness of these interventions emphasises the need for well-designed, adequately powered, randomised controlled clinical trials.

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Background: 

Cystic fibrosis is the most common, life-threatening, recessively inherited disease of Caucasian populations. It is a multisystem disorder caused by a mutation in the gene encoding the cystic fibrosis transmembrane conductance regulator protein which is important in producing sweat, digestive juices and mucus.The impaired or absent function of this protein results in the production of viscous mucus within the lungs and an environment that is susceptible to chronic airway obstruction and pulmonary colonization by a range of pathogenic bacteria. Morbidity and mortality of cystic fibrosis is related to chronic pulmonary sepsis and its complications by these bacteria.

Influenza can worsen the course of the disease in cystic fibrosis by increasing the risk of pneumonia and secondary respiratory complications. Antiviral agents form an important part of influenza management and include the neuraminidase inhibitors zanamivir and oseltamivir. These inhibitors can limit the infection and prevent the spread of the virus.

Objectives: 

To assess the effects of neuraminidase inhibitors for the treatment of influenza infection in people with cystic fibrosis.

Search strategy: 

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.

Most recent search: 08 July 2013.

Selection criteria: 

Randomised controlled trials and quasi-randomised controlled trials comparing neuraminidase inhibitors with placebo or other antiviral drugs.

Data collection and analysis: 

Two review authors had planned to independently screen studies, extract data and assess risk of bias using standard Cochrane Collaboration methodologies. No studies were identified for inclusion.

Main results: 

No relevant studies were retrieved after a comprehensive search of the literature.