Neuraminidase Inhibitors for All Patients with Suspected Influenza?
DOI: 10.3238/zfa.2019.0483-0488german translation / full article
AntwortQuestionIn the middle of the 2019/20 influenza-season, the question arises whether there are therapeutical options in addition or as a surrogate for vaccination which prevent or shorten influenza and help to avoid complications and reduce mortality. With this intention, antiviral treatment against influenza is frequently prescribed for any patient with confirmed or suspected influenza during regional influenza outbreaks. Do we have reliable evidence from clinical trials regarding this treatment option?AnswerThe evidence from clinical trials for relevant treatment effects of neuraminidase-inhibitors is weak because of the poor quality of existing studies. Clinicians should consider antiviral treatment with oseltamivir or zanamivir only for persons with high risk of complications (patients hospitalized with influenza, outpatients with severe or progressive illness, outpatients who are at high risk of complications, patients with chronic medical conditions, immunocompromised patients, children younger than 2 years, adults ≥ 65 years, pregnant women and those within 2 weeks postpartum). Either drug has only minor effects on reducing the time to alleviation of influenza symptoms. There is no reliable evidence that neuraminidase inhibitors prevent complications or reduce mortality. As prophylaxis, they possibly reduce the risk of developing symptomatic influenza. The question whether the complications of influenza (such as pneumonia) are reduced cannot be answered from existing studies. Adverse effects, such as nausea, vomiting, psychiatric effects and renal events in adults and vomiting in children should be considered when making the treatment decision.