UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Prevention of seasonal influenza with antiviral drugs in adults

Author
Kimon C Zachary, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Anna R Thorner, MD

INTRODUCTION

Influenza is a communicable but preventable viral illness. Annual immunization is the most important preventive measure [1] and is recommended for all individuals over six months of age in the United States [2]. However, antiviral drugs are available and play an important adjunctive role for patients who have not been immunized or who may not develop immunity from the vaccine.

Two classes of antiviral drugs are available for the prevention and treatment of influenza [3,4]:

The neuraminidase inhibitors, zanamivir and oseltamivir, which are active against both influenza A and B

The adamantanes, amantadine and rimantadine, which are only active against influenza A. Due to a marked increase in resistant isolates, these agents should generally not be used in the United States for preventive therapy except in selected circumstances, which are discussed below. (See 'Choice of antiviral drug' below.)

The role of these drugs in the prevention of seasonal influenza will be reviewed here. The role of antiviral drugs for the treatment of seasonal influenza, the prevention and treatment of pandemic H1N1 influenza and avian influenza, the prevention and treatment of influenza in children, and the pharmacologic characteristics of the these agents are discussed separately. Influenza vaccination is also reviewed separately. (See "Treatment of seasonal influenza in adults" and "Treatment and prevention of pandemic H1N1 influenza ('swine influenza')" and "Treatment and prevention of avian influenza" and "Seasonal influenza in children: Prevention and treatment with antiviral drugs" and "Pharmacology of antiviral drugs for influenza" and "Seasonal influenza vaccination in adults" and "Seasonal influenza in children: Prevention with vaccines".)

                                

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Fri Oct 28 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Glezen WP. Clinical practice. Prevention and treatment of seasonal influenza. N Engl J Med 2008; 359:2579.
  2. Centers for Disease Control and Prevention (CDC). Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices--United States, 2013-2014. MMWR Recomm Rep 2013; 62:1.
  3. Ong AK, Hayden FG. John F. Enders lecture 2006: antivirals for influenza. J Infect Dis 2007; 196:181.
  4. Fiore AE, Fry A, Shay D, et al. Antiviral agents for the treatment and chemoprophylaxis of influenza --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60:1.
  5. CDC health alert. CDC recommends against the use of amantadine and rimantadine for the treatment or prophylaxis of influenza in the United States during the 2005–06 influenza season. www.cdc.gov/flu/han011406.htm (Accessed on January 17, 2006).
  6. Cooper NJ, Sutton AJ, Abrams KR, et al. Effectiveness of neuraminidase inhibitors in treatment and prevention of influenza A and B: systematic review and meta-analyses of randomised controlled trials. BMJ 2003; 326:1235.
  7. Jefferson T, Demicheli V, Rivetti D, et al. Antivirals for influenza in healthy adults: systematic review. Lancet 2006; 367:303.
  8. Hayden FG, Atmar RL, Schilling M, et al. Use of the selective oral neuraminidase inhibitor oseltamivir to prevent influenza. N Engl J Med 1999; 341:1336.
  9. Welliver R, Monto AS, Carewicz O, et al. Effectiveness of oseltamivir in preventing influenza in household contacts: a randomized controlled trial. JAMA 2001; 285:748.
  10. Hayden FG, Belshe R, Villanueva C, et al. Management of influenza in households: a prospective, randomized comparison of oseltamivir treatment with or without postexposure prophylaxis. J Infect Dis 2004; 189:440.
  11. Monto AS, Robinson DP, Herlocher ML, et al. Zanamivir in the prevention of influenza among healthy adults: a randomized controlled trial. JAMA 1999; 282:31.
  12. Hayden FG, Gubareva LV, Monto AS, et al. Inhaled zanamivir for the prevention of influenza in families. Zanamivir Family Study Group. N Engl J Med 2000; 343:1282.
  13. Monto AS, Pichichero ME, Blanckenberg SJ, et al. Zanamivir prophylaxis: an effective strategy for the prevention of influenza types A and B within households. J Infect Dis 2002; 186:1582.
  14. Kashiwagi S, Watanabe A, Ikematsu H, et al. Long-acting Neuraminidase Inhibitor Laninamivir Octanoate as Post-exposure Prophylaxis for Influenza. Clin Infect Dis 2016; 63:330.
  15. LaForce C, Man CY, Henderson FW, et al. Efficacy and safety of inhaled zanamivir in the prevention of influenza in community-dwelling, high-risk adult and adolescent subjects: a 28-day, multicenter, randomized, double-blind, placebo-controlled trial. Clin Ther 2007; 29:1579.
  16. Peters PH Jr, Gravenstein S, Norwood P, et al. Long-term use of oseltamivir for the prophylaxis of influenza in a vaccinated frail older population. J Am Geriatr Soc 2001; 49:1025.
  17. Bowles SK, Lee W, Simor AE, et al. Use of oseltamivir during influenza outbreaks in Ontario nursing homes, 1999-2000. J Am Geriatr Soc 2002; 50:608.
  18. Parker R, Loewen N, Skowronski D. Experience with oseltamivir in the control of a nursing home influenza B outbreak. Can Commun Dis Rep 2001; 27:37.
  19. Vu D, Peck AJ, Nichols WG, et al. Safety and tolerability of oseltamivir prophylaxis in hematopoietic stem cell transplant recipients: a retrospective case-control study. Clin Infect Dis 2007; 45:187.
  20. Fry AM, Goswami D, Nahar K, et al. Effects of oseltamivir treatment of index patients with influenza on secondary household illness in an urban setting in Bangladesh: secondary analysis of a randomised, placebo-controlled trial. Lancet Infect Dis 2015; 15:654.
  21. Jefferson T, Jones M, Doshi P, et al. Oseltamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments. BMJ 2014; 348:g2545.
  22. Heneghan CJ, Onakpoya I, Thompson M, et al. Zanamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments. BMJ 2014; 348:g2547.
  23. Centers for Disease Control and Prevention (CDC). Update: influenza activity--United States, 1998-99 season. MMWR Morb Mortal Wkly Rep 1999; 48:25.
  24. Schilling M, Povinelli L, Krause P, et al. Efficacy of zanamivir for chemoprophylaxis of nursing home influenza outbreaks. Vaccine 1998; 16:1771.
  25. Lee C, Loeb M, Phillips A, et al. Zanamivir use during transmission of amantadine-resistant influenza A in a nursing home. Infect Control Hosp Epidemiol 2000; 21:700.
  26. Dolin R. Resistance to neuraminidase inhibitors. Clin Infect Dis 2011; 52:438.
  27. www.cdc.gov/flu/weekly/index.htm (Accessed on September 22, 2008).
  28. World Health Organization. WHO/ECDC frequently asked questions for Oseltamivir Resistance. http://www.who.int/csr/disease/influenza/oseltamivir_faqs/en/ (Accessed on February 04, 2008).
  29. Hayden FG, de Jong MD. Emerging influenza antiviral resistance threats. J Infect Dis 2011; 203:6.
  30. Centers for Disease Control and Prevention (CDC). Update: influenza activity --- United States, October 3-December 11, 2010. MMWR Morb Mortal Wkly Rep 2010; 59:1651.
  31. Centers for Disease Control and Prevention (CDC). Update: influenza activity - United States, 2009-10 season. MMWR Morb Mortal Wkly Rep 2010; 59:901.
  32. Drugs for non-HIV viral infections. Treat Guidel Med Lett 2007; 5:59.
  33. Relenza dear doctor letter in EU follow U.S. advisory. In: "The Pink Sheet" F-D-C Reports, Chevy Chase, MD, January 31, 2000, p. 20.
  34. Antiviral drugs for prophylaxis and treatment of influenza. Med Lett Drugs Ther 2005; 47:93.
  35. Hayden FG, Belshe RB, Clover RD, et al. Emergence and apparent transmission of rimantadine-resistant influenza A virus in families. N Engl J Med 1989; 321:1696.
  36. Degelau J, Somani SK, Cooper SL, et al. Amantadine-resistant influenza A in a nursing facility. Arch Intern Med 1992; 152:390.
  37. Dolin R, Reichman RC, Madore HP, et al. A controlled trial of amantadine and rimantadine in the prophylaxis of influenza A infection. N Engl J Med 1982; 307:580.
  38. Monto AS, Ohmit SE, Hornbuckle K, Pearce CL. Safety and efficacy of long-term use of rimantadine for prophylaxis of type A influenza in nursing homes. Antimicrob Agents Chemother 1995; 39:2224.
  39. Centers for Disease Control and Prevention. Influenza antiviral medications: summary for clinicians. http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm (Accessed on December 03, 2015).
  40. Harper SA, Bradley JS, Englund JA, et al. 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.
  41. United States Centers for Disease Control and Prevention. Updated recommendations for obstetric health care providers related to use of antiviral medications in the treatment and prevention of influenza for the 2010-2011 season. http://www.cdc.gov/flu/professionals/antivirals/avrec_ob2011.htm (Accessed on January 11, 2011).
  42. Rasmussen SA, Jamieson DJ, Bresee JS. Pandemic influenza and pregnant women. Emerg Infect Dis 2008; 14:95.
  43. Mak TK, Mangtani P, Leese J, et al. Influenza vaccination in pregnancy: current evidence and selected national policies. Lancet Infect Dis 2008; 8:44.
  44. Kwong JC, Campitelli MA, Rosella LC. Obesity and respiratory hospitalizations during influenza seasons in Ontario, Canada: a cohort study. Clin Infect Dis 2011; 53:413.
  45. Centers for Disease Control and Prevention (CDC). Recommended adult immunization schedules--United States, 2008. MMWR Morb Mortal Wkly Rep 2007; 56:Q1.
  46. Monto AS, Rotthoff J, Teich E, et al. Detection and control of influenza outbreaks in well-vaccinated nursing home populations. Clin Infect Dis 2004; 39:459.
  47. Rubin MS, Nivin B, Ackelsberg J. Effect of timing of amantadine chemoprophylaxis on severity of outbreaks of influenza a in adult long-term care facilities. Clin Infect Dis 2008; 47:47.
  48. Tanaka T, Nakajima K, Murashima A, et al. Safety of neuraminidase inhibitors against novel influenza A (H1N1) in pregnant and breastfeeding women. CMAJ 2009; 181:55.
  49. Cox S, Posner SF, McPheeters M, et al. Hospitalizations with respiratory illness among pregnant women during influenza season. Obstet Gynecol 2006; 107:1315.
  50. United States Food and Drug Administration. MedWatch Safety Alert. Relenza (zanamivir) inhalation powder. www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm186081.htm (Accessed on October 09, 2009).
  51. CDC issues interim recommendations for the use of influenza antiviral medications in the setting of oseltamivir resistance among circulating influenza A (H1N1) viruses, 2008-09 influenza season. http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00279 (Accessed on December 22, 2008).
  52. http://www.fda.gov/cder/news/relenza/default.htm (Accessed on October 06, 2008).