Marek Smieja, MD, PhD
Are neuraminidase inhibitors effective for preventing or treating influenza in healthy adults? What are the adverse effects?
Included studies compared neuraminidase inhibitors (oseltamivir or zanamivir) with placebo, antiviral controls, or no treatment in otherwise-healthy persons who were exposed to naturally occurring influenza. Studies had to include ≥ 75% of persons 14 to 60 years of age. Outcomes were influenza, influenza-like illness, influenza symptoms and complications (pneumonia, bronchitis, sinusitis, and otitis media requiring antibiotics in laboratory-confirmed influenza), and adverse effects.
MEDLINE and EMBASE/Excerpta Medica (to Aug 2009); Cochrane CENTRAL (Cochrane Library 2009, Issue 3); a previous Cochrane review*; and reference lists were searched for randomized controlled trials (RCTs) or quasi-RCTs of effectiveness, and studies reporting adverse effects. 20 trials met the selection criteria, and 5 had adequate quality using Cochrane Collaboration criteria.
The main results are in the Table. No significant adverse effects were found in trials of zanamivir (no data reported).
In healthy adults, neuraminidase inhibitors relieve influenza symptoms and reduce risk for laboratory-confirmed influenza but not influenza-like illness or influenza complications.
Oseltamivir or zanamivir vs placebo for influenza in otherwise healthy adults†
†HR = hazard ratio; NR = not reported; NS = not significant; other abbreviations defined in Glossary. RRI, RRR, NNT, NNH, and CI calculated from data in article using a random-effects model.
‡Revised data (RR 0.48, 95% CI 0.31 to 0.75) confirmed by author.
§Includes pneumonia, bronchitis, otitis media, and sinusitis.
||HR > 1 favors treatment.
Smieja M. Review: Neuraminidase inhibitors relieve influenza symptoms and reduce laboratory-confirmed influenza in healthy adults. Ann Intern Med. ;152:JC2–11. doi: 10.7326/0003-4819-152-4-201002160-02011
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Published: Ann Intern Med. 2010;152(4):JC2-11.
Infectious Disease, Influenza, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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