Amantadine and rimantadine for preventing and treating influenza A in adults

Jefferson, Tom; Demicheli,; Deeks, John M.; Rivetti, D

doi:10.1002/14651858.cd001169

Cited by 48 publications

(30 citation statements)

References 48 publications

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“…The increasing availability of office and reference laboratory tests to diagnose influenza [1][2][3][4] and the development of viable treatments for the disease 5,6 make it more important than ever to make the best possible use of the history and physical examination (HPE) to accurately establish the pretest probability. Patients with a low likelihood of influenza based on the HPE and a negative in-office test have a very low likelihood of influenza, whereas those with a high pretest probability and a negative test may still have a clinically important likelihood of the disease.…”

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confidence: 99%

A Systematic Review of the History and Physical Examination to Diagnose Influenza

Ebell¹,

White²,

Casault³

2004

The Journal of the American Board of Family Medicine

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Background: Although influenza is a commonly encountered condition in primary care, and diagnosis is increasingly important given the availability of new treatments, there has been no systematic review of the evidence on clinical diagnosis.Methods: This was a systematic review of the literature with meta-analysis where appropriate. We included cohort studies and randomized trials that compared the history and physical examination with a reference laboratory test for the diagnosis of influenza A and/or B. The primary outcomes were the sensitivity, specificity, likelihood ratios, and area under the receiver-operating characteristic (ROC) curve.Results: Seven studies reported the sensitivity and specificity for a total of 59 variables. We combined studies of influenza A or B alone with those of influenza A and B. Rigors [likelihood ratio (LR) ؉7.2], the combination of fever and presenting within 3 days of the onset of illness (LR ؉4.0), and sweating (LR ؉3.0) were best at ruling-in influenza when present. When absent, the following decreased the likelihood of influenza: any systemic symptoms (LR ؊0.36), coughing (LR ؊0.38), not being able to cope with daily activities (LR ؊0.39), and being confined to bed (LR ؊0.50). Cough, nasal congestion, and fever (subjective or objective) had the highest calculable areas under the ROC curve.Conclusions

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confidence: 99%

A Systematic Review of the History and Physical Examination to Diagnose Influenza

Ebell¹,

White²,

Casault³

2004

The Journal of the American Board of Family Medicine

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“…The benefi t of early treatment was based on reports that treatment decreases symptoms 24 hours earlier than no treatment. 4,5 The economic impact assigned to this benefi t was increased productivity based on the patient being able to return to work (or having a caretaker return to work) 1 day earlier.…”

Section: Testing For Influenza Amentioning

confidence: 99%

“…1 Although the impact of infl uenza and infl uenzalike illness on productivity and health care resource utilization in a working population is great, 2 most morbidity and mortality related to the illness are seen primarily in the elderly and those with underlying respiratory tract conditions. 3 For patients who have not been vaccinated, antiviral treatments can reduce the risk of complications, [4][5][6][7] but treatment must be started within 48 hours to provide any benefi t, and confi rming the diagnosis of infl uenza by viral culture is not practical for clinicians. Consequently, clinicians have had to judge the likelihood of infl uenza, as opposed to other respiratory tract illnesses, based on clinical probability and initiate empiric therapy.…”

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confidence: 99%

A Cost-Benefit Analysis of Testing for Influenza A in High-Risk Adults

Hueston

Benich²

2004

The Annals of Family Medicine

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BACKGROUND Clinical diagnosis and empiric therapy have been strategies for treatment of suspected infl uenza in high-risk patients, but rapid tests for infl uenza have been introduced to help confi rm cases. The aim of this study was to determine when rapid testing, empiric treatment, or no treatment is most cost-beneficial for high-risk adults with infl uenzalike respiratory tract illnesses. METHODSWe performed a cost-benefi t analysis evaluating the comparative advantage of the strategies of empiric therapy, no treatment, or test and treat patients whose tests are positive. The analysis focused on a hypothetical population of patients who are at a high-risk for complications of infl uenza. Our main outcome was the cost of care for an episode of infl uenza taken from the human capital perspective. RESULTSFor older anti-infl uenza drugs (amantadine and rimantadine), rapid testing is not as cost-benefi cial as empiric treatment, even when the prevalence of infl uenza is low. For the neuraminidase inhibitors, there is a narrow window of disease prevalence between 30% and 40% where testing is most cost-benefi cial. When the disease likelihood is above this window, empiric treatment is preferred. Below this window, no treatment is more cost-benefi cial. Even under the most favorable conditions, testing is preferred only for a small range of prevalence rates of infl uenza.CONCLUSION When clinicians are planning to use the nonneuraminidase inhibitors to treat infl uenza, rapid testing is not the most cost-benefi cial approach. Even when the more expensive neuraminidase inhibitors will be used, testing has a limited role in managing infl uenza in high-risk patients.

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“…Antiviral activity is mediated by binding these agents to the M2 protein ion channels on the viral envelope, preventing acidic conditions within the virus that are required for uncoating and subsequent release of viral nucleic acid into the host cell. 34 Only influenza A virus contains the M2 protein. A different envelope protein that does not bind to the adamantanes provides a similar function in influenza B virus; amantadine and rimantadine are not active against influenza B.…”

Section: Introductionmentioning

confidence: 99%

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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Amantadine and rimantadine for preventing and treating influenza A in adults

Cited by 48 publications

References 48 publications

A Systematic Review of the History and Physical Examination to Diagnose Influenza

A Systematic Review of the History and Physical Examination to Diagnose Influenza

A Cost-Benefit Analysis of Testing for Influenza A in High-Risk Adults

Antiviral Therapy and Prophylaxis for Influenza in Children

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