The battle against influenza: The role of neuraminidase inhibitors in children

Abstract

The neuraminidase inhibitors are an important advance in the treatment of influenza infections. In contrast to amantadine and rimantadine, the neuraminidase inhibitors are active against both influenza A and B. Oseltamivir and zanamivir are not approved for the prevention of influenza infection. Data are limited in children younger than 12 years of age. Safety profiles appear promising with respect to the potential use of these agents in children. However, both agents are more expensive than amantadine and rimantadine. This is particularly important given the extent of the clinical gain reported in trials. In this regard, cost effectiveness considerations will feature prominently as physicians consider the role of these agents in the treatment of influenza infections in healthy children. Firm paediatric recommendations cannot be made at this time because of the lack of data. Current recommendations, therefore, remain structured around the use of amantadine and rimantadine. Thus, at the present time, therapy for influenza virus infection should be considered for children at increased risk for severe or complicated influenza infection, otherwise healthy children with a severe illness, and persons with very special environmental, family or social situations. In these situations, zanamivir or oseltamivir may be used if the child is of the appropriate age (Table 1).