Neuraminidase inhibitors for preventing and treating influenza in children

Matheson, Nicholas J; Harnden, Anthony; Perera, Rafael; Sheikh, Aziz; Symmonds‐Abrahams, M

doi:10.1002/14651858.cd002744.pub2

Cited by 118 publications

(60 citation statements)

References 55 publications

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“…9 It concluded that neuraminidase inhibitors were effective in shortening the duration of illness and showed no significant effect on prophylaxis. This review, which included an additional treatment trial, found insufficient data to allow pooling, but the effects reported are consistent enough to conclude that treatment results in 0.5 to 1.5 day reduction in influenza symptoms or illness, or both.…”

Section: Discussionmentioning

confidence: 99%

“…8 The last update of our Cochrane review of this treatment was in 2005 and included three treatment trials and one prophylaxis trial. 9 We need an accurate, up to date assessment of the benefits and harms of oseltamivir and zanamivir so that national bodies, clinicians, and parents can make evidence informed decisions about treating and preventing influenza in children. We assessed the current evidence for the effectiveness, safety, and tolerability of neuraminidase inhibitors for the treatment and prevention of influenza in children.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials

Shun-Shin

Thompson

Heneghan

et al. 2009

BMJ

133

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Objective To assess the effects of the neuraminidase inhibitors oseltamivir and zanamivir in treatment of children with seasonal influenza and prevention of transmission to children in households.Design Systematic review and meta-analysis of data from published and unpublished randomised controlled trials.Data sources Medline and Embase to June 2009, trial registries, and manufacturers and authors of relevant studies.Review methods Eligible studies were randomised controlled trials of neuraminidase inhibitors in children aged ≤12 in the community (that is, not admitted to hospital) with confirmed or clinically suspected influenza. Primary outcome measures were time to resolution of illness and incidence of influenza in children living in households with index cases of influenza.Results We identified four randomised trials of treatment of influenza (two with oseltamivir, two with zanamivir) involving 1766 children (1243 with confirmed influenza, of whom 55-69% had influenza A), and three randomised trials for postexposure prophylaxis (one with oseltamivir, two with zanamivir) involving 863 children; none of these trials tested efficacy with the current pandemic strain. Treatment trials showed reductions in median time to resolution of symptoms or return to normal activities, or both, of 0.5-1.5 days, which were significant in only two trials. A 10 day course of postexposure prophylaxis with zanamivir or oseltamivir resulted in an 8% (95% confidence interval 5% to 12%) decrease in the incidence of symptomatic influenza. Based on only one trial, oseltamivir did not reduce asthma exacerbations or improve peak flow in children with asthma. Treatment was not associated with reduction in overall use of antibiotics (risk difference −0.30, −0.13 to 0.01). Zanamivir was well tolerated, but oseltamivir was associated with an increased risk of vomiting (0.05, 0.02 to 0.09, number needed to harm=20).Conclusions Neuraminidase inhibitors provide a small benefit by shortening the duration of illness in children with seasonal influenza and reducing household transmission. They have little effect on asthma exacerbations or the use of antibiotics. Their effects on the incidence of serious complications, and on the current A/H1N1 influenza strain remain to be determined.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials

Shun-Shin

Thompson

Heneghan

et al. 2009

BMJ

133

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“…The neuraminidase inhibitors generally are well-tolerated 80,81 , with few adverse events occurring more frequently than with placebo 69,70 . Oseltamivir may cause mild to moderate nausea and vomiting, which usually occurs during the first 2 days and is more frequent with the higher daily dose of 150 mg 69,80 .…”

Section: Which Groups and Individuals Are At Increased Risk For Complmentioning

confidence: 99%

2009 update in prevention, evaluation, and outpatient treatment of influenza

Williams

2009

Current Medical Research and Opinion

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“…Nevertheless, there is also no definitive evidence to confirm the importance of immediate pre-hospital treatment as no prospective trial of immediate or delayed treatment has been undertaken. The retrospective studies which have been reported, including the most recent by Harnden et al in 2006,9 are confounded by selection bias, as the sickest children are more likely to receive pre-hospital penicillin. In the absence of a randomised controlled trial, we support the current UK recommendation for the general practitioner to administer parenteral antibiotics as soon as meningococcal disease is diagnosed 7 10.…”

Section: Treatmentmentioning

confidence: 99%