Oral oseltamivir treatment of influenza in children

Whitley, Richard J.; Hayden, Frederick G.; Reisinger, Keith S.; Young, Nancy L.; Dutkowski, Regina; Ipe, David; Mills, Roger; Ward, Penelope

doi:10.1097/00006454-200102000-00002

Cited by 652 publications

(491 citation statements)

References 17 publications

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“…39 However, timely administration of oseltamivir has been associated with shorter hospitalizations among critically ill children, 40 faster resolution of illness (1.0-1.5 days in healthy children), and less parental work absenteeism. [41][42][43] Also, 43% to 44% fewer outpatient children who received oseltamivir within 48 hours of influenza symptoms developed acute otitis media. [43][44][45] When the 2009 pandemic influenza began in the United States in mid-April 2009, recommendations were made for expanded use of antiviral medications and were associated with increased antiviral usage 46 ; thus, usage patterns from before versus after the 2009 pandemic may differ.…”

Section: Figurementioning

confidence: 99%

The Burden of Influenza in Young Children, 2004–2009

Poehling

Edwards²,

Griffin³

et al. 2013

Pediatrics

163

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OBJECTIVE: To characterize the health care burden of influenza from 2004 through 2009, years when influenza vaccine recommendations were expanded to all children aged ≥6 months. METHODS: Population-based surveillance for laboratory-confirmed influenza was performed among children aged <5 years presenting with fever and/or acute respiratory illness to inpatient and outpatient settings during 5 influenza seasons in 3 US counties. Enrolled children had nasal/throat swabs tested for influenza by reverse transcriptase-polymerase chain reaction and their medical records reviewed. Rates of influenza hospitalizations per 1000 population and proportions of outpatients (emergency department and clinic) with influenza were computed. RESULTS: The study population comprised 2970, 2698, and 2920 children from inpatient, emergency department, and clinic settings, respectively. The single-season influenza hospitalization rates were 0.4 to 1.0 per 1000 children aged <5 years and highest for infants <6 months. The proportion of outpatient children with influenza ranged from 10% to 25% annually. Among children hospitalized with influenza, 58% had physician-ordered influenza testing, 35% had discharge diagnoses of influenza, and 2% received antiviral medication. Among outpatients with influenza, 7% were tested for influenza, 7% were diagnosed with influenza, and <1% had antiviral treatment. Throughout the 5 study seasons, <45% of influenza-negative children ≥6 months were fully vaccinated against influenza. CONCLUSIONS: Despite expanded vaccination recommendations, many children are insufficiently vaccinated, and substantial influenza burden remains. Antiviral use was low. Future studies need to evaluate trends in use of vaccine and antiviral agents and their impact on disease burden and identify strategies to prevent influenza in young infants.

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Section: Figurementioning

confidence: 99%

The Burden of Influenza in Young Children, 2004–2009

Poehling

Edwards²,

Griffin³

et al. 2013

Pediatrics

163

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“…During human clinical trials, oseltamivir resistance was detected in < 1-4% of adults [8,9] and 5-6% of treated children [10] undergoing oseltamivir treatment, although in observational studies the frequency of resistance in oseltamivir treated children has been as high as 27% [11]. Most significantly, oseltamivir-resistant seasonal A(H1N1) viruses with an H275Y mutation became widespread during 2008, spreading globally even in regions of low drug usage [12,13].…”

Section: Introductionmentioning

confidence: 99%

Zanamivir-resistant influenza viruses with Q136K or Q136R neuraminidase residue mutations can arise during MDCK cell culture creating challenges for antiviral susceptibility monitoring

et al. 2015

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Surveillance of circulating influenza strains for antiviral susceptibility is important to ensure patient treatment guidelines remain appropriate. Influenza A(H3N2) and A(H1N1)pdm09 virus isolates containing mutations at the Q136 residue of the neuraminidase (NA) that conferred reduced susceptibility to the NA inhibitor (NAI) zanamivir were detected during antiviral susceptibility monitoring. Interestingly, the mutations were not detectable in the viruses from respective clinical specimens, only in the cultured isolates. We showed that variant viruses containing the Q136K and Q136R NA mutations were preferentially selected in MadinDarby canine kidney epithelial (MDCK) cells, but were less well supported in MDCK-SIAT1 cells and embryonated eggs. The effect of Q136K, Q136R, Q136H and Q136L substitutions in NA subtypes N1 and N2 on NAI susceptibility and in vitro viral fitness was assessed. This study highlights the challenges that cell culture derived mutations can pose to the NAI susceptibility analysis and interpretation and reaffirms the need to sequence viruses from respective clinical specimens to avoid misdiagnosis. However, we also demonstrate that NA mutations at residue Q136 can confer reduced zanamivir, peramivir or laninamivir susceptibility, and therefore close monitoring of viruses for mutations at this site from patients being treated with these antivirals is important.

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“…29 In a multicenter study in the United States, only 5% of children who received oseltamivir therapy developed in vitro resistance in influenza isolates cultured during therapy. 14 In contrast, a study from Japan documented resistance of 18% in isolates cultured from 50 oseltamivir-treated children. 12,30 Fortunately, oseltamivir-resistant isolates from children do not seem to be as capable of sustaining infection as wild-type strains as assessed in animal models of influenza infection.…”

Section: Antiviral Resistancementioning

confidence: 97%

Antiviral Therapy and Prophylaxis for Influenza in Children

2007

Pediatrics

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Antiviral agents are available that are safe and effective for the treatment and prophylaxis of influenza virus infections in children. The neuraminidase inhibitors (oseltamivir [Tamiflu] and zanamivir [Relenza]) are preferred agents because of current widespread resistance to the adamantanes (amantadine [Symmetrel] and rimantadine [Flumadine]). Therapy should be provided to children with influenza infection who are at high risk of severe infection and to children with moderateto-severe influenza infection who may benefit from a decrease in the duration of symptoms. Prophylaxis should be provided (1) to high-risk children who have not yet received immunization and during the 2 weeks after immunization, (2) to unimmunized family members and health care professionals with close contact with high-risk unimmunized children or infants who are younger than 6 months, and (3) for control of influenza outbreaks in unimmunized staff and children in an institutional setting. Testing of current H5N1 avian influenza virus isolates, the potential agents of pandemic influenza, suggests susceptibility to oseltamivir and zanamivir. Because no prospective data exist on the efficacy of these agents in humans for H5N1 strains, the dosage and duration of therapy in adults and children may differ from those documented to be effective for epidemic influenza strains. INTRODUCTIONAntiviral agents for treatment and prophylaxis of influenza are safe and effective in children. Annual immunization against influenza is the preferred strategy for prevention of infection, but certain situations exist in which the use of antiviral agents is beneficial.The morbidity and mortality of epidemic influenza in unimmunized children is substantial, particularly in those younger than 2 years. 1-5 The purpose of this report is to offer guidance regarding antiviral treatment and prophylaxis to clinicians caring for children during yearly influenza epidemics and to provide resources for information on antiviral treatment in the event of an influenza pandemic, because no prospective human data currently exist on which to base recommendations for treatment of infections caused by potential H5N1 pandemic influenza virus strains. All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. ANTIVIRAL DRUGS FOR EPIDEMIC AND PANDEMIC INFLUENZAThe guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

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Oral oseltamivir treatment of influenza in children

Abstract: Oral oseltamivir administration is an efficacious and well-tolerated therapy for influenza in children when given within 48 h of onset of illness.

Cited by 652 publications

References 17 publications

The Burden of Influenza in Young Children, 2004–2009

The Burden of Influenza in Young Children, 2004–2009

Zanamivir-resistant influenza viruses with Q136K or Q136R neuraminidase residue mutations can arise during MDCK cell culture creating challenges for antiviral susceptibility monitoring

Antiviral Therapy and Prophylaxis for Influenza in Children

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