Efficacy and Safety of Oseltamivir in Children: Systematic Review and Individual Patient Data Meta-analysis of Randomized Controlled Trials

Malosh, Ryan E.; Martin, Emily T.; Heikkinen, Terho; Brooks, W. Abdullah; Whitley, Richard J.; Monto, Arnold S.

doi:10.1093/cid/cix1040

Cited by 115 publications

(95 citation statements)

References 35 publications

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“…Notably, FDA-approved antiviral medications for treatment of influenza are approved for early treatment of uncomplicated influenza in outpatients based upon randomized placebo-controlled clinical trials conducted among previously healthy outpatients. Meta-analyses of randomized placebo-controlled clinical trials of early oseltamivir treatment of influenza in pediatric and adult outpatients have reported clinical benefit in reducing duration of illness and risk for some complications associated with influenza [65,66].…”

Section: Treatment Of Influenzamentioning

confidence: 99%

Influenza virus-related critical illness: prevention, diagnosis, treatment

2019

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Annual seasonal influenza epidemics of variable severity result in significant morbidity and mortality in the United States (U.S.) and worldwide. In temperate climate countries, including the U.S., influenza activity peaks during the winter months. Annual influenza vaccination is recommended for all persons in the U.S. aged 6 months and older, and among those at increased risk for influenza-related complications in other parts of the world (e.g. young children, elderly). Observational studies have reported effectiveness of influenza vaccination to reduce the risks of severe disease requiring hospitalization, intensive care unit admission, and death. A diagnosis of influenza should be considered in critically ill patients admitted with complications such as exacerbation of underlying chronic comorbidities, community-acquired pneumonia, and respiratory failure during influenza season. Molecular tests are recommended for influenza testing of respiratory specimens in hospitalized patients. Antigen detection assays are not recommended in critically ill patients because of lower sensitivity; negative results of these tests should not be used to make clinical decisions, and respiratory specimens should be tested for influenza by molecular assays. Because critically ill patients with lower respiratory tract disease may have cleared influenza virus in the upper respiratory tract, but have prolonged influenza viral replication in the lower respiratory tract, an endotracheal aspirate (preferentially) or bronchoalveolar lavage fluid specimen (if collected for other diagnostic purposes) should be tested by molecular assay for detection of influenza viruses. Observational studies have reported that antiviral treatment of critically ill adult influenza patients with a neuraminidase inhibitor is associated with survival benefit. Since earlier initiation of antiviral treatment is associated with the greatest clinical benefit, standard-dose oseltamivir (75 mg twice daily in adults) for enteric administration is recommended as soon as possible as it is well absorbed in critically ill patients. Based upon observational data that suggest harms, adjunctive corticosteroid treatment is currently not recommended for children or adults hospitalized with influenza, including critically ill patients, unless clinically indicated for another reason, such as treatment of asthma or COPD exacerbation, or septic shock. A number of pharmaceutical agents are in development for treatment of severe influenza.

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Section: Treatment Of Influenzamentioning

confidence: 99%

Influenza virus-related critical illness: prevention, diagnosis, treatment

2019

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“…The sialic acid cleavage activity of NA is required for release of virions from infected epithelial cells and also facilitates migration through the epithelial mucin layer (189,190). Benefit from NA inhibitors is primarily restricted to uncomplicated disease where treatment is instituted within the first 48 h of symptoms with a modest reduction in duration of illness (191,192). A recently approved antiviral, baloxavir marboxil, acts as a selective inhibitor of influenza cap endonuclease (193).…”

Section: Targeting Iav and S Pneumoniae At The Mucosal Barriermentioning

confidence: 99%

Respiratory Barrier as a Safeguard and Regulator of Defense Against Influenza A Virus and Streptococcus pneumoniae

et al. 2020

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The primary function of the respiratory system of gas exchange renders it vulnerable to environmental pathogens that circulate in the air. Physical and cellular barriers of the respiratory tract mucosal surface utilize a variety of strategies to obstruct microbe entry. Physical barrier defenses including the surface fluid replete with antimicrobials, neutralizing immunoglobulins, mucus, and the epithelial cell layer with rapidly beating cilia form a near impenetrable wall that separates the external environment from the internal soft tissue of the host. Resident leukocytes, primarily of the innate immune branch, also maintain airway integrity by constant surveillance and the maintenance of homeostasis through the release of cytokines and growth factors. Unfortunately, pathogens such as influenza virus and Streptococcus pneumoniae require hosts for their replication and dissemination, and prey on the respiratory tract as an ideal environment causing severe damage to the host during their invasion. In this review, we outline the host-pathogen interactions during influenza and post-influenza bacterial pneumonia with a focus on interand intra-cellular crosstalk important in pulmonary immune responses.

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“…To treat influenza, antiviral medications can be used. Oseltamivir, an antiviral agent, is used to treat seasonal or pandemic influenza in adults and children . Oseltamivir is a neuraminidase inhibitor, which prevents the reproduction of the influenza virus.…”

Section: Introductionmentioning

confidence: 99%

“…Oseltamivir, an antiviral agent, is used to treat seasonal or pandemic influenza in adults and children. 5,6 Oseltamivir is a neuraminidase inhibitor, which prevents the reproduction of the influenza virus. It is available both as a tablet and in a liquid form and is recommended for people with a high risk of complications and should be taken within 48 hours of the first symptoms of influenza.…”

Section: Introductionmentioning

confidence: 99%

Healthcare professionals’ queries on oseltamivir and influenza in Finland 2011‐2016—Can we detect influenza epidemics with specific online searches?

Pesälä

Virtanen

Mukka

et al. 2019

Influenza Resp Viruses

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Background Healthcare professionals (HCPs) search medical information during their clinical work using Internet sources. In Finland, Physician's Databases (PD) serve as an Internet medical portal aimed at HCPs. Influenza epidemics appear seasonal outbreaks causing public health concern. Oseltamivir can be used to treat influenza. Little is known about HCPs’ queries on oseltamivir and influenza from dedicated online medical portals and whether queries could be used as an additional source of information for disease surveillance when detecting influenza epidemics. Methods We compared HCPs’ queries on oseltamivir and influenza from PD to influenza diagnoses from the primary healthcare register in Finland 2011‐2016. The Moving Epidemic Method (MEM) calculated the starts of influenza epidemics. Laboratory reports of influenza A and influenza B were assessed. Paired differences compared queries, diagnoses, and laboratory reports by using starting weeks. Kendall's correlation test assessed the season‐to‐season similarity. Results We found that PD and the primary healthcare register showed visually similar patterns annually. Paired differences in the mean showed that influenza epidemics based on queries on oseltamivir started earlier than epidemics based on diagnoses by −0.80 weeks (95% CI: −1.0, 0.0) with high correlation ( τ = 0.943). Queries on influenza preceded queries on oseltamivir by −0.80 weeks (95% CI: −1.2, 0.0) and diagnoses by −1.60 weeks (95% CI: −1.8, −1.0). Conclusions HCPs’ queries on oseltamivir and influenza from Internet medical databases correlated with register diagnoses of influenza. Therefore, they should be considered as a supplementary source of information for disease surveillance when detecting influenza epidemics.

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Efficacy and Safety of Oseltamivir in Children: Systematic Review and Individual Patient Data Meta-analysis of Randomized Controlled Trials

Cited by 115 publications

References 35 publications

Influenza virus-related critical illness: prevention, diagnosis, treatment

Influenza virus-related critical illness: prevention, diagnosis, treatment

Respiratory Barrier as a Safeguard and Regulator of Defense Against Influenza A Virus and Streptococcus pneumoniae

Healthcare professionals’ queries on oseltamivir and influenza in Finland 2011‐2016—Can we detect influenza epidemics with specific online searches?

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