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

Abstract

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of transmission to children in households.Design Systematic review and meta-analysis of data from published and unpublished randomised controlled trials.Data sources Medline and Embase to June 2009, trial registries, and manufacturers and authors of relevant studies.Review methods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.

Follow-up Formula Consumption in 3- to 4-Year-Olds and Respiratory Infections: An RCT

“…36 A dietary approach, however, does not have the risks of adverse events linked to the use of antiviral drugs. 37 The prevalence of allergic diseases reported in 3-to 4-year-old children in China is lower than the prevalence in some Western countries, especially for asthma (2.2%-9.7%), although it is increasing. 38 It has been a matter of debate whether exposure to early infections is a risk or a protective factor against later allergic disease.…”

Risk of severe outcomes among patients admitted to hospital with pandemic (H1N1) influenza

“…Children are considered key transmitters of influenza and responsible for seeding households with the infection, so their likelihood of exposure may have been higher in the first wave. 19 The risk of death from seasonal influenza is highest among people 70 years of age or older, and hospital admissions because of seasonal influenza are highest among children less than two years old and adults over 65 years. 3,20 In the case of pandemic (H1N1) influenza, hospital admissions and severe outcomes occurred in all age groups and in a much younger Canadian population than seasonal influenza typically does.…”

Properties of polysaccharides in several seaweeds from Atlantic Canada and their potential anti-influenza viral activities

“…Using oseltamivir, a viral neuraminidase inhibitor, to treat influenza (von Itzstein 2007) is being confounded by the rise of resistant H1N1 influenza strains and emerging resistant influenza A seasonal strains (Bantia, Parker et al 2001;Matheson, Harnden et al 2008;Shun-Shin, Thompson et al 2009). …”