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Prevention of seasonal influenza in adults

INTRODUCTION

Influenza is a communicable but preventable viral illness. Annual immunization for targeted populations is the most important preventive measure [1]. 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 [2,3]:

  • 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 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 swine H1N1 influenza and avian influenza, the prevention and treatment of influenza in children, and the pharmacologic characteristics of the these agents are discussed separately. (See "Treatment of seasonal influenza in adults" and "Treatment of pandemic H1N1 influenza ('swine influenza')" and "Prevention of pandemic H1N1 influenza ('swine influenza')" and "Treatment and prevention of avian influenza" and "Antiviral drugs for the prevention and treatment of influenza in children" and "Pharmacology of antiviral drugs for influenza".)

NEURAMINIDASE INHIBITORS

Oseltamivir is a neuraminidase inhibitor that is available as a capsule or powder for liquid suspension. It is generally well tolerated. Zanamivir is a neuraminidase inhibitor that is taken by inhalation. Inhaled zanamivir is relatively contraindicated in patients with underlying asthma or other chronic respiratory conditions. (See 'Adverse effects' below.)
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