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Antivirals for Influenza

Strategies for Use in Pediatrics

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Abstract

Influenza infection is annually responsible for significant morbidity and mortality, particularly among the very young and old. Recently updated guidelines recommend influenza vaccination of all children aged 6 months to 18 years; however, childhood vaccination remains underutilized. Furthermore, concerns over the reduced efficacy of vaccination in children have further heightened the need for effective treatment schemes. Antiviral therapies have emerged as attractive options in the battle against influenza infection. These agents include the adamantanes (amantadine and rimantadine) and neuraminidase inhibitors (zanamivir, oseltamivir, and peramivir). Broad-scale use of adamantane antivirals has been severely limited in recent years because of high resistance rates and their inability to cover influenza type B. Neuraminidase inhibitors cover influenza types A and B, and have been promulgated to first-line therapy because of historically low resistance rates and relatively infrequent side effects. Moreover, these agents are effective options in combating non-seasonal influenza strains, including H5N1 and pandemic 2009 H1N1. Oseltamivir may be particularly appealing for treating children since it is available in multiple oral dosage formulations, whereas commercially available zanamivir use is limited in young children because it requires inhalation. However, the emergence of resistance to oseltamivir among influenza A strains may limit its usefulness. Additional concerns with neuraminidase inhibitor use in pediatrics center around emerging reports, primarily from Japan, that have temporally linked oseltamivir to significant neuropsychiatric events in children of varying ages. Numerous novel antiviral agents are under development, but most are far from market approval. In addition to treating and preventing the initial burden of pediatric influenza infection, antiviral therapies may significantly reduce secondary bacterial infections (including pneumonia and otitis media), unnecessary antibiotic prescribing, and healthcare-associated costs.

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Acknowledgements

No sources of funding were used in the preparation of this review. Dr Smith has no conflicts of interest to disclose. Dr Gums has received grant support from Roche Pharmaceuticals.

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Authors and Affiliations

  1. Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA

    Steven M. Smith & John G. Gums

  2. Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA

    Steven M. Smith & John G. Gums

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  1. Steven M. Smith
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  2. John G. Gums
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Correspondence to Steven M. Smith.

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Smith, S.M., Gums, J.G. Antivirals for Influenza. Pediatr-Drugs 12, 285–299 (2010). https://doi.org/10.2165/11532530-000000000-00000

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