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Neuraminidase inhibitors for preventing and treating influenza in healthy adultsJefferson TO, Demicheli V, Di Pietrantonj C, Jones M, Rivetti D
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SummaryInfluenza is an acute infection of the airways and the whole body, caused by a virusSymptoms include fever, headache and cough. Serious complications such as pneumonia can also occur. This review of trials found that neuraminidase inhibitors (Nls) such as zanamivir and oseltamivir are effective in preventing ("prophylaxis") and treating ("treatment") the symptoms and complications of influenza but do not prevent infection or interrupt voidance of viruses from the nose. Oseltamivir causes nausea, vomiting and retching while zanamivir causes diarrhoea. There is no evidence that NIs may be effective against bird flu. Because of their performance, NI should not be used on their own, but alongside barrier (masks, gloves), personal hygiene and quarantine measures.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
April 26. 1999 AbstractBackgroundNeuraminidase inhibitors (NI) are recommended for use against influenza and its complications in interpandemic years and in a pandemic. ObjectivesTo assess the effects of NIs in preventing or ameliorating influenza, its transmission and its complications in healthy adults and to estimate the frequency of adverse effects. Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005), MEDLINE (2004 to September, Week 4 2005), EMBASE (2003 to June 2005) and contacted manufacturers, researchers in the field, and authors of studies evaluated in the review. Selection criteriaRandomised or quasi-randomised placebo-controlled studies of NIs in healthy adults exposed to naturally occurring influenza. Data collection and analysisTwo authors applied inclusion criteria, assessed trial quality and extracted data. We structured the comparisons into prophylaxis, treatment and adverse events with further subdivision by outcome and dose. Main resultsWe identified four prophylaxis, 13 treatment and four post-exposure prophylaxis (PEP) trials. In prophylaxis compared to placebo, NIs have no effect against influenza-like illnesses (ILI) (relative risk (RR) 1.28, 95% confidence interval (CI) 0.45 to 3.66 for oral oseltamivir 75 mg daily; RR 1.51, 95% CI 0.77 to 2.95 for inhaled zanamivir 10 mg daily). The efficacy of oral oseltamivir 75 mg daily against symptomatic influenza is 61% (RR 0.39, 95% CI 0.18 to 0.85), or 73% (RR 0.27, 95% CI 0.11 to 0.67) at 150 mg daily. Inhaled zanamivir 10 mg daily is 62% efficacious (RR 0.38, 95% CI 0.17 to 0.85). Neither NI has a significant effect on asymptomatic influenza. Oseltamivir induces nausea (odds ratio (OR) 1.79, 95% CI 1.10 to 2.93). Oseltamivir for PEP has an efficacy of 58.5% (15.6% to 79.6) for households and of 68% (34.9 to 84.2%) to 89% in contacts of index cases. Zanamivir has similar performance. The hazard ratios for time to alleviation of influenza symptoms were in favour of the treated group 1.33 (1.29 to 1.37) for zanamivir and 1.30 (1.13 to 1.50) for oseltamivir. Viral nasal titres were significantly diminished by both NIs. Oseltamivir 150 mg daily prevented lower respiratory tract complications (OR 0.32, 95% CI 0.18 to 0.57). We could find no comparative data on the effects of oseltamivir on avian influenza. Authors' conclusionsBecause of their low effectiveness, NIs should not be used in routine seasonal influenza control. In a serious epidemic or pandemic, NIs should be used with other public health measures. We are unsure of the generalisability of our conclusions from seasonal to pandemic or avian influenza. |