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El-Alfy NZI, Sakr SM, Mahmoud MF, Omar HA. Effects of Tamiflu and Adamine on histology and ultrastructure of the liver of albino mice. EGYPTIAN LIVER JOURNAL 2021. [DOI: 10.1186/s43066-021-00112-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Tamiflu (Oseltamivir) and Adamine (Amantadine HCl) are antiviral drugs which are used for prevention and treatment for influenza. The present study was carried out to evaluate the effect of Tamiflu and Adamine on the liver of adult male albino mice from the histological and ultrastructural points of views.
Results
Histological examination of liver sections treated with Tamiflu and Adamine included enlargement and congestion of central and hepatic veins in addition to erosion of their endothelial lining cells, cytoplasmic vacuolation of hepatocytes, pyknosis of their nuclei, and dilatation of hepatic sinusoid. The electron microscopic investigation illustrated mitochondrial swelling, fragmented rough endoplasmic reticulum, cytoplasmic vacuolation, the nuclei with irregular envelope and condensed heterochromatin, dilated microvilli in sinusoid, in addition to active Kupffer cells have many lysosomes and filopodia in its membrane.
Conclusion
The study suggested that both drugs induced histopathological and ultrastructural alterations in hepatic tissue. In conclusion, Tamiflu and Adamine have pathological effects on liver of albino mice (Mus musculus).
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Vecoso LVZ, Silva MT, Resende MR, da Silva EN, Galvao TF. Cost-Effectiveness Analysis of Influenza A (H1N1) Chemoprophylaxis in Brazil. Front Pharmacol 2019; 10:945. [PMID: 31572172 PMCID: PMC6749104 DOI: 10.3389/fphar.2019.00945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 07/24/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Oseltamivir and zanamivir are recommended for treating and preventing influenza A (H1N1) worldwide. In Brazil, this official recommendation lacks an economic evaluation. Our objective was to assess the efficiency of influenza A chemoprophylaxis in the Brazilian context. Methods: We assessed the cost-effectiveness of oseltamivir and zanamivir for prophylaxis of influenza for high risk population, compared to no prophylaxis, in the perspective of Brazilian public health system. Quality-adjusted life years (QALY) and effectiveness data were based on literature review and costs in Brazilian real (BRL) were estimated from official sources and micro-costing of 2016's H1N1 admissions at a university hospital. We used a decision-tree model considering prophylaxis and no prophylaxis and the probabilities of H1N1, ambulatory care, admission to hospital, intensive care, patient discharge, and death. Adherence and adverse events from prophylaxis were included. Incremental cost-effectiveness ratio was converted to 2016 United States dollar (USD). Uncertainty was assessed with univariated and probabilistic sensitivity analysis. Results: Adherence to prophylaxis was 0.70 [95% confidence interval (CI) 0.54; 0.83]; adverse events, 0.09 (95% CI 0.02; 0.18); relative risk of H1N1 infection in chemoprophylaxis, 0.43 (95% CI 0.33; 0.57); incidence of H1N1, 0.14 (95% CI 0.11; 0.16); ambulatory care, 0.67 (95% CI 0.58; 0.75); hospital admission, 0.43 (CI 95% 0.39; 0.42); hospital mortality, 0.14 (CI 95% 0.12; 0.15); intensive care unit admission, 0.23 (95% CI 0.20; 0.27); and intensive care mortality, 0.40 (95% CI 0.29; 0.52). QALY in H1N1 state was 0.50 (95% CI 0.46; 0.53); in H1N1 inpatients, 0.23 (95% CI 0.18; 0.28); healthy, 0.885 (95% CI 0.879; 0.891); death, 0. Adverse events estimated to affect QALY in -0.185 (95% CI -0.290; -0.050). Cost for chemoprophylaxis was BRL 39.42 [standard deviation (SD) 17.94]; ambulatory care, BRL 12.47 (SD 5.21); hospital admission, BRL 5,727.59 (SD 7,758.28); intensive care admission, BRL 19,217.25 (SD 7,917.33); and adverse events, BRL 292.05 (SD 724.95). Incremental cost-effectiveness ratio was BRL -4,080.63 (USD -1,263.74)/QALY and -982.39 (USD -304.24)/H1N1 prevented. Results were robust to sensitivity analysis. Conclusion: Chemoprophylaxis of influenza A (H1N1) is cost-saving in Brazilian health system context.
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Lowe C, Leung V, Karakas L, Merrick L, Lawson T, Romney M, Ritchie G, Payne M. Targeted management of influenza A/B outbreaks incorporating the cobas® Influenza A/B & RSV into the virology laboratory. J Hosp Infect 2019; 101:38-41. [DOI: 10.1016/j.jhin.2018.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
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Murray MT, Heitkemper E, Jackson O, Neu N, Stone P, Cohen B, Saiman L, Hutcheon G, Larson EL. Direct costs of acute respiratory infections in a pediatric long-term care facility. Influenza Other Respir Viruses 2016; 10:34-6. [PMID: 26425787 PMCID: PMC4687501 DOI: 10.1111/irv.12350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 01/01/2023] Open
Abstract
Acute respiratory tract infections (ARI) are a major burden in pediatric long‐term care. We analyzed the financial impact of ARI in 2012–2013. Costs associated with ARI during the respiratory viral season were ten times greater than during the non‐respiratory viral season, $31 224 and $3242 per 1000 patient‐days, respectively (P < 0·001). ARI are burdensome for pediatric long‐term care facilities not only because of the associated morbidity and mortality, but also due to the great financial costs of prevention.
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Affiliation(s)
- Meghan T Murray
- School of Nursing, Columbia University Medical Center, New York, NY, USA
| | | | | | - Natalie Neu
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Patricia Stone
- School of Nursing, Columbia University Medical Center, New York, NY, USA
| | - Bevin Cohen
- School of Nursing, Columbia University Medical Center, New York, NY, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.,Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Elaine L Larson
- School of Nursing, Columbia University Medical Center, New York, NY, USA
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Lim JK, Kilgore PE, Aiello AE, Foxman B, Letson GW, Jang GY, Chung E, Song YH, Kim YK. Impact of time to treatment of oseltamivir on influenza hospitalization cost among Korean children. Pediatr Int 2015; 57:393-400. [PMID: 25330041 DOI: 10.1111/ped.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 08/09/2014] [Accepted: 10/02/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although oseltamivir is a common influenza treatment, there is a lack of data on the economic benefits of timely oseltamivir treatment. METHODS From February 2004 through June 2007, 116 hospitalized children ≤ 15 years of age with laboratory-confirmed influenza who received oseltamivir were identified via retrospective medical chart review. Demographic, clinical, and cost data were abstracted and multivariate linear regression was used to assess the association between oseltamivir time to treatment and treatment-related costs among hospitalized children with laboratory-confirmed influenza. RESULTS Overall, 28% (n = 33) of patients were treated with oseltamivir ≥ day 3 of admission. Rapid influenza diagnostic test was used in a significantly lower proportion of patients treated with oseltamivir ≥ day 3 of admission compared with those who received oseltamivir earlier. On multivariate linear regression, initiation of oseltamivir ≥ day 3 of admission was associated with a 60.84% increase (95%CI: 32.59-95.11) in treatment-related hospital costs, compared with initiation on admission. CONCLUSION Delayed initiation of oseltamivir was found to be associated with increased treatment-related hospital costs among children hospitalized with laboratory-confirmed influenza.
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Affiliation(s)
| | - Paul E Kilgore
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, USA
| | - Allison E Aiello
- Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
| | - Betsy Foxman
- Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
| | | | - Gi-Young Jang
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Eunhee Chung
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Young-Hwan Song
- Department of Pediatrics, Inje College of Medicine, Seoul, Korea
| | - Yun-Kyung Kim
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
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Alves Galvão MG, Rocha Crispino Santos MA, Alves da Cunha AJL. Amantadine and rimantadine for influenza A in children and the elderly. Cochrane Database Syst Rev 2014; 2014:CD002745. [PMID: 25415374 PMCID: PMC7093890 DOI: 10.1002/14651858.cd002745.pub4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Influenza is an acute respiratory illness caused by influenza A and B viruses. Complications may occur, especially among children and the elderly. OBJECTIVES To assess the effectiveness and safety of amantadine and rimantadine in preventing, treating and shortening the duration of influenza A in children and the elderly. SEARCH METHODS We searched CENTRAL (2014, Issue 9), MEDLINE (1966 to September week 4, 2014) and EMBASE (1980 to October 2014). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs comparing amantadine and/or rimantadine with no intervention, placebo, other antivirals or different doses or schedules of amantadine or rimantadine in children and the elderly with influenza A. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the search results. We extracted and analysed data using the standard Cochrane methodology. MAIN RESULTS We identified 12 studies (2494 participants: 1586 children and 908 elderly) comparing amantadine and rimantadine with placebo, paracetamol (one trial: 69 children) or zanamivir (two trials: 545 elderly) to treat influenza A.Amantadine was effective in preventing influenza A in children (773 participants, risk ratio (RR) 0.11; 95% confidence interval (CI) 0.04 to 0.30). The assumed risk of influenza A in the control group was 10 per 100. The corresponding risk in the rimantadine group was one per 100 (95% CI 0 to 3). Nevertheless, the quality of the evidence was low and the safety of the drug was not well established.For treatment, rimantadine was beneficial in abating fever on day three of treatment in children: one selected study with low risk of bias, moderate evidence quality and 69 participants (RR 0.36; 95% CI 0.14 to 0.91). The assumed risk was 38 per 100. The corresponding risk in the rimantadine group was 14 per 100 (95% CI 5 to 34).Rimantadine did not show any prophylactic effect in the elderly. The quality of evidence was very low: 103 participants (RR 0.45; 95% CI 0.14 to 1.41). The assumed risk was 17 per 100. The corresponding risk in the rimantadine group was 7 per 100 (95% CI 2 to 23).There was no evidence of adverse effects caused by treatment with amantadine or rimantadine.We found no studies assessing amantadine in the elderly. AUTHORS' CONCLUSIONS The quality of the evidence combined with a lack of knowledge about the safety of amantadine and the limited benefits of rimantadine, do not indicate that amantadine and rimantadine compared to control (placebo or paracetamol) could be useful in preventing, treating and shortening the duration of influenza A in children and the elderly.
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Affiliation(s)
- Márcia G Alves Galvão
- Municipal Secretariat of HealthAvenida Ayrton Senna, 250/ 205Barra da Tijuca. Alfa Barra 1Rio de JaneiroRJBrazil22793‐000
| | | | - Antonio JL Alves da Cunha
- School of Medicine, Federal University of Rio de JaneiroDepartment of PediatricsAv. Carlos Chagas Filho, 373Edificio do CCS ‐ Bloco K ‐ 2o. andar, Sala K49Rio de JaneiroRio de JaneiroBrazil21941‐902
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Postma MJ, Baltussen RP, Palache AM, Wilschut JC. Further evidence for favorable cost-effectiveness of elderly influenza vaccination. Expert Rev Pharmacoecon Outcomes Res 2012; 6:215-27. [PMID: 20528557 DOI: 10.1586/14737167.6.2.215] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Vaccination represents the single most cost-effective strategy to avert influenza-related morbidity, mortality and economic consequences. This review presents an analysis of the pharmacoeconomic aspects of influenza vaccination of the elderly. The methodology of the analysis focuses on the main drivers of the pharmacoeconomic profile of elderly influenza vaccination, in particular the vaccine effectiveness in terms of prevention of hospitalization and mortality, the background incidence of hospitalization and death in unvaccinated individuals and the relative costing of the vaccine compared with the costs of a hospital in-patient day. The variation in outcomes between different studies could partly be explained by differences in the main drivers defined above. This review demonstrates that the pharmacoeconomic profile of elderly influenza vaccination is highly favorable. From the vast majority of studies it appears that financial benefits of elderly influenza vaccination surpass the costs and that, when this is not the case, cost-effectiveness in terms of net costs per life-year gained is acceptable.
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Affiliation(s)
- Maarten J Postma
- University of Groningen, Groningen University Institute for Drug Exploration (GUIDE), Department of Social Pharmacy, Pharmacoepidemiology & Pharmacotherapy, Groningen, The Netherlands.
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Plans P. Recommendations for the prevention and treatment of influenza using antiviral drugs based on cost-effectiveness. Expert Rev Pharmacoecon Outcomes Res 2012; 8:563-73. [PMID: 20528367 DOI: 10.1586/14737167.8.6.563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Influenza is an acute respiratory disease that causes epidemics and pandemics in the human population of temperate regions. Influenza epidemics occur every year during the winter months, affecting approximately 10% of the population. The primary strategy for reducing the effect of influenza in the community is to vaccinate persons who are at risk or caring for high-risk individuals each year before seasonal increases in influenza virus circulation occur. Antiviral drugs can be used for the treatment of influenza and the prevention of seasonal and post-exposure influenza. Four antiviral drugs are available for the prevention and treatment of influenza infections: oseltamivir, zanamivir, rimantadine and amantadine. Antiviral drugs can be used for the treatment of influenza and for post-exposure and seasonal influenza prevention. The cost-effectiveness of antiviral therapies ranged from cost savings to more than US$130,000 per quality-adjusted life-year (QALY) for influenza treatment, from GB pound9000 to more than pound1 million per QALY for seasonal prevention and from cost savings to pound100,000 per QALY for post-exposure prevention. Based on the cost-effectiveness threshold of pound30,000 or $40,000 per QALY, antiviral therapies can be recommended for influenza treatment and post-exposure prevention in healthy and high-risk individuals and for seasonal prevention in high-risk individuals. Zanamivir, oseltamivir and amantadine have favorable cost-effectiveness ratios for these interventions, but amantadine should only be used in countries with a low prevalence of resistant virus. The stockpile of antiviral drugs should be maintained in developed countries because they are cost effective for the prevention and treatment of a possible influenza pandemic.
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Affiliation(s)
- Pedro Plans
- Direcció General de Salut Pública, Departament de Salut, Generalitat de Catalunya, Roc Boronat 83-95, Barcelona 08005, Spain.
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Quach C, McArthur M, McGeer A, Li L, Simor A, Dionne M, Lévesque E, Tremblay L. Risk of infection following a visit to the emergency department: a cohort study. CMAJ 2012; 184:E232-9. [PMID: 22271915 DOI: 10.1503/cmaj.110372] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The risk of infection following a visit to the emergency department is unknown. We explored this risk among elderly residents of long-term care facilities. METHODS We compared the rates of new respiratory and gastrointestinal infections among elderly residents aged 65 years and older of 22 long-term care facilities. We used standardized surveillance definitions. For each resident who visited the emergency department during the study period, we randomly selected two residents who did not visit the emergency department and matched them by facility unit, age and sex. We calculated the rates and proportions of new infections, and we used conditional logistic regression to adjust for potential confounding variables. RESULTS In total, we included 1269 residents of long-term care facilities, including 424 who visited the emergency department during the study. The baseline characteristics of residents who did or did not visit the emergency department were similar, except for underlying health status (visited the emergency department: mean Charlson Comorbidity Index 6.1, standard deviation [SD] 2.5; did not visit the emergency department: mean Charlson Comorbidity index 5.5, SD 2.7; p < 0.001) and the proportion who had visitors (visited the emergency department: 46.9%; did not visit the emergency department: 39.2%; p = 0.01). Overall, 21 (5.0%) residents who visited the emergency department and 17 (2.0%) who did not visit the emergency department acquired new infections. The incidence of new infections was 8.3/1000 patient-days among those who visited the emergency department and 3.4/1000 patient-days among those who did not visit the emergency department. The adjusted odds ratio for the risk of infection following a visit to the emergency department was 3.9 (95% confidence interval 1.4-10.8). INTERPRETATION A visit to the emergency department was associated with more than a threefold increased risk of acute infection among elderly people. Additional precautions should be considered for residents following a visit to the emergency department.
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Affiliation(s)
- Caroline Quach
- Division of Infectious Disease, Department of Pediatrics and Medical Microbiology, The Montreal Children's Hospital, McGill University, Montréal, Que.
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Alves Galvão MG, Rocha Crispino Santos MA, Alves da Cunha AJ. Amantadine and rimantadine for influenza A in children and the elderly. Cochrane Database Syst Rev 2012; 1:CD002745. [PMID: 22258950 DOI: 10.1002/14651858.cd002745.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The effectiveness and safety of amantadine (AMT) and rimantadine (RMT) for preventing and treating influenza A in adults has been systematically reviewed. However, little is known about these treatments in children and the elderly. OBJECTIVES To systematically review the effectiveness and safety of AMT and RMT in preventing and treating influenza A in children and the elderly. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2) which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register, MEDLINE (1966 to June week 3, 2011) and EMBASE (1980 to June 2011). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs comparing AMT and/or RMT with placebo, control, other antivirals or different doses or schedules of AMT or RMT, or both, or no intervention, in children and the elderly. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion and assessed methodological quality. We resolved disagreements by consensus. In all comparisons except for one, we separately analysed the trials in children and the elderly using Review Manager software. MAIN RESULTS A total of 12 studies involving 2494 participants (1586 children and adolescents and 908 elderly) compared AMT and RMT with placebo, paracetamol (one trial; 69 children) or zanamivir (two trials; 545 seniors). All studies were RCTs but most were still susceptible to bias. Two trials in the elderly had a high risk of bias because of incomplete outcome data. In one of those trials there was also a lack of outcome assessment blinding. Risk of bias was unclear in 10 studies due to unclear random sequence generation and allocation concealment. Only two trials in children were considered to have a low risk of bias.AMT was effective in preventing influenza A in children. A total of 773 participants were included in this outcome (risk ratio (RR) 0.11; 95% confidence interval (CI) 0.04 to 0.30). The assumed risk of influenza in the control group was 10 per 100 and the corresponding risk in the RMT group was one per 100 (95% CI 0 to 3). The quality of the evidence was considered low. For treatment purposes, RMT was beneficial for abating fever on day three of treatment. For this purpose one study was selected with low risk of bias and included 69 children (RR 0.36; 95% CI 0.14 to 0.91). The assumed risk was 38 per 100 and the corresponding risk in the RMT group was 14 per 100, 95% CI 5 to 34. The quality of the evidence was moderate.RMT did not show a prophylactic effect against influenza in the elderly, but the quality of evidence was considered very low. There were 103 participants (RR 0.45; 95% CI 0.14 to 1.41, for an assumed risk of 17 per 100 and a corresponding risk in the RMT group of 7 per 100, 95% CI 2 to 23). We did not identify any AMT trials in the elderly that met our inclusion criteria.There was no evidence of adverse effects of AMT and RMT in children or an adverse effect of RMT in the elderly. We did not identify any AMT trials in the elderly that met our inclusion criteria. AUTHORS' CONCLUSIONS AMT is effective in preventing influenza A in children but the NNTB is high (NNTB: 12 (95% CI 9 to 17). RMT probably helps the abatement of fever on day three of treatment, but the quality of the evidence is poor. Due to the small number of available studies, we could not reach a definitive conclusion on the safety of AMT or the effectiveness of RMT in preventing influenza in children and the elderly.
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Lee BY, Bailey RR, Wiringa AE, Assi TM, Beigi RH. Antiviral medications for pregnant women for pandemic and seasonal influenza: an economic computer model. Obstet Gynecol 2009; 114:971-980. [PMID: 20168096 PMCID: PMC3388110 DOI: 10.1097/aog.0b013e3181bdbfed] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To estimate the economic value of administering antiviral medications to pregnant women who have come in contact with an infectious individual with influenza. METHODS A computer-simulation model was developed to predict the potential economic effect of antiviral use for postexposure prophylaxis among pregnant women in both seasonal influenza and pandemic influenza scenarios. The model allowed us to examine the effects of varying influenza exposure risk, antiviral efficacy, antiviral cost, and the probability of different influenza outcomes such as hospitalization, preterm delivery, and mortality. RESULTS For a variety of pandemic influenza scenarios (attack rate 20% or more, probability of preterm birth for women with influenza 12% or more, mortality for a preterm neonate 2% or more, and probability of influenza-attributable hospitalization 4.8% or more), the postexposure prophylactic use of antiviral medications was strongly cost-effective, with incremental cost-effectiveness ratio values below $50,000 per quality-adjusted life-year. Antiviral prophylaxis became an economically dominant strategy (that is, less costly and more effective) when the influenza attack rate is 20% or more and preterm birth rate is 36% or more, and when attack rate is 30% or more and preterm birth rate is 24% or more. Antiviral prophylaxis was not cost-effective under seasonal influenza conditions. CONCLUSION These findings support the use of antiviral medications for postexposure prophylaxis among pregnant women in a pandemic influenza scenario but not in a seasonal influenza setting.
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Affiliation(s)
- Bruce Y Lee
- From the Section of Decision Sciences and Clinical Systems Modeling, School of Medicine; Department of Biomedical Informatics, School of Medicine; Department of Epidemiology, Graduate School of Public Health; and Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
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Alvis N, la Hoz FD, Darío Gómez R. Medicamentos antivirales para la epidemia de influenza: efectividad y costo-efectividad del oseltamivir. INFECTIO 2009. [DOI: 10.1016/s0123-9392(09)70153-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ruf BR, Szucs T. Reducing the Burden of Influenza-Associated Complications with Antiviral Therapy. Infection 2009; 37:186-96. [DOI: 10.1007/s15010-009-8241-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 12/18/2008] [Indexed: 10/20/2022]
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Harper SA, Bradley JS, Englund JA, File TM, Gravenstein S, Hayden FG, McGeer AJ, Neuzil KM, Pavia AT, Tapper ML, Uyeki TM, Zimmerman RK. Seasonal influenza in adults and children--diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:1003-32. [PMID: 19281331 PMCID: PMC7107965 DOI: 10.1086/598513] [Citation(s) in RCA: 495] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Guidelines for the treatment of persons with influenza virus infection were prepared by an Expert Panel of the Infectious Diseases Society of America. The evidence-based guidelines encompass diagnostic issues, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal (interpandemic) influenza. They are intended for use by physicians in all medical specialties with direct patient care, because influenza virus infection is common in communities during influenza season and may be encountered by practitioners caring for a wide variety of patients.
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Affiliation(s)
- Scott A Harper
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Gravenstein S. Initiating influenza chemoprophylaxis with the first influenza case: a new institutional standard? Clin Infect Dis 2008; 47:53-5. [PMID: 18484877 DOI: 10.1086/588659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Alves Galvão MG, Rocha Crispino Santos MA, Alves da Cunha AJL. Amantadine and rimantadine for influenza A in children and the elderly. Cochrane Database Syst Rev 2008:CD002745. [PMID: 18254006 DOI: 10.1002/14651858.cd002745.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although amantadine (AMT) and rimantadine (RMT) are used to relieve or treat influenza A symptoms in healthy adults, little is known about the effectiveness and safety of these antivirals in preventing and treating influenza A in children and the elderly. OBJECTIVES The aim of this review was to systematically consider evidence on the effectiveness and safety of AMT and RMT in preventing and treating influenza A in children and the elderly. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2007, issue 3); MEDLINE (1966 to July 2007) and EMBASE (1980 to July 2007). SELECTION CRITERIA Randomised or quasi-randomised trials comparing AMT and/or RMT in children and the elderly with placebo, control, other antivirals or comparing different doses or schedules of AMT and/or RMT or no intervention. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion and assessed methodological quality. Disagreements were resolved by consensus. In all comparisons except for one, the trials in children and in the elderly were analysed separately. Data were analysed and reported using Cochrane Review Manager 4.2. software. MAIN RESULTS In children, RMT was effective in the abatement of fever on day three of treatment. AMT showed a prophylactic effect against influenza A infection. AMT and RMT were not related to an increase in the occurrence of adverse effects. RMT also was considered to be well tolerated by the elderly, but showed no prophylactic effect. Different doses were comparable in the prophylaxis of influenza in the elderly, as well as in reporting adverse effects. Zanamivir prevented influenza A more effectively than RMT in the elderly. AUTHORS' CONCLUSIONS AMT was effective in the prophylaxis of influenza A in children. As confounding matters might have affected our findings, caution should be taken when considering which patients should to be given this prophylactic. Our conclusions about effectiveness of both antivirals for the treatment of influenza A in children were limited to a proven benefit of RMT in the abatement of fever on day three of treatment. Due to the small number of available studies we could not reach a definitive conclusion on the safety of AMT or the effectiveness of RMT in preventing influenza in children and the elderly.
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van der Sande MAB, Ruijs WLM, Meijer A, Cools HJM, van der Plas SM. Use of oseltamivir in Dutch nursing homes during the 2004-2005 influenza season. Vaccine 2006; 24:6664-9. [PMID: 16797806 DOI: 10.1016/j.vaccine.2006.05.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To assess the implementation of guidelines for using neuraminidase inhibitors in the control of influenza outbreaks in Dutch nursing homes, data were collected on prophylactic and therapeutic use of anti-viral medication, indications for use and criteria for prescribing, based on experiences during the influenza season 2004-2005 in a retrospective cross-sectional survey among Dutch nursing homes after the 2004-2005 season. Ninety/194 (49%) participating nursing homes reported an outbreak of influenza-like illness; in 57/194 (29%) influenza was laboratory confirmed. In 37/57 homes (65%) oseltamivir had been used as prophylaxis. Prophylactic use was extended to all residents and staff in 6/37 (16%) of homes, but limited in the others. In 9/37 (24%) no staff were issued prophylaxis. Among clinicians with laboratory confirmed influenza, 41/46 (89%) had used oseltamivir therapeutically. Main reasons for not prescribing oseltamivir for prophylaxis and/or therapy were lack of scientific evidence, high costs, and absent or delayed laboratory confirmation. Logistical bottlenecks in diagnosis, cost-effectiveness concerns, and lack of an evidence-base hamper full integration in policy and should be addressed.
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Affiliation(s)
- Marianne A B van der Sande
- Centre for Infectious Disease Epidemiology, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
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