Oseltamivir and Risk of Lower Respiratory Tract Complications in Patients With Flu Symptoms: A Meta-analysis of Eleven Randomized Clinical Trials

Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 06/2011; 53(3):277-9. DOI: 10.1093/cid/cir400
Source: PubMed


An independent reanalysis of 11 randomized clinical trials shows that oseltamivir treatment reduces the risk of lower respiratory tract complications requiring antibiotic treatment by 28% overall (95% confidence interval [CI], 11%-42%) and by 37% among patients with confirmed influenza infections (95% CI, 18%-52%).

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    • "March 2015 | Volume 6 | Article 140 | 7 Tan et al. Avian influenza A H7N9 virus et al., 2000; Lalezari et al., 2001; Whitley et al., 2001; Sato et al., 2005; Cowling et al., 2010; Heinonen et al., 2010; Yu et al., 2010; Hernán and Lipsitch, 2011). However, the novel H7N9 virus confers resistance to both rimantadine and amantadine which are M2-ion channel blockers, and as such they are not recommended for use in treatment (Li et al., 2014; Qi et al., 2014). "
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    ABSTRACT: The novel avian influenza A H7N9 virus which caused the first human infection in Shanghai, China; was reported on the 31st of March 2013 before spreading rapidly to other Chinese provinces and municipal cities. This is the first time the low pathogenic avian influenza A virus has caused human infections and deaths; with cases of severe respiratory disease with pneumonia being reported. There were 440 confirmed cases with 122 fatalities by 16 May 2014; with a fatality risk of ∼28%.The median age of patients was 61 years with a male-to-female ratio of 2.4:1. The main source of infection was identified as exposure to poultry and there is so far no definitive evidence of sustained person-to-person transmission. The neuraminidase inhibitors, namely oseltamivir, zanamivir, and peramivir; have shown good efficacy in the management of the novel H7N9 virus. Treatment is recommended for all hospitalized patients, and for confirmed and probable outpatient cases; and should ideally be initiated within 48 h of the onset of illness for the best outcome. Phylogenetic analysis found that the novel H7N9 virus is avian in origin and evolved from multiple reassortments of at least four origins. Indeed the novel H7N9 virus acquired human adaptation via mutations in its eight RNA gene segments. Enhanced surveillance and effective global control are essential to prevent pandemic outbreaks of the novel H7N9 virus.
    Frontiers in Microbiology 03/2015; 6(140):1-11. DOI:10.3389/fmicb.2015.00140 · 3.99 Impact Factor
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    • "older version of Turner et al . , replaced by Burch et al . [ 8 ] and Tappenden et al . [ 18 ] Heneghan CJ . Health Technology Assessment programme , 2011 , HTA - 32011001126 [ 58 ] only a protocol version , final version not available Hernán MA et al . Clin Infect Dis . 2011 [ 34 ] no systematic literature search , no critical quality appraisal for the included RCTs"
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    ABSTRACT: Controversy has arisen regarding the effectiveness of neuraminidase inhibitors (NIs), especially against influenza-related complications. A literature search was performed to critically assess the evidence collected by the available systematic reviews (SRs) regarding the benefits and disadvantages of NIs (oseltamivir, zanamivir) compared to placebos in healthy and at-risk individuals of all ages for prophylaxis and treatment of seasonal influenza. A SR was done using the Cochrane Database of Systematic Reviews, Health Technology Assessment Database, Database of Abstracts of Reviews of Effects, and Medline (January 2006-July 2012). Two reviewers selected SRs based on randomized clinical trials, which were restricted to intention-to-treat results, and they assessed review (AMSTAR) and study quality indicators (GRADE). The SRs included (N = 9) were of high quality. The efficacy of NIs in prophylaxis ranged from 64% (16-85) to 92% (37-99); the absolute risk reduction ranged from 1.2% to 12.1% (GRADE moderate to low). Clinically relevant treatment benefits of NIs were small in healthy adults and children suffering from influenza-like illness (GRADE high to moderate). Oseltamivir reduced antibiotic usage in healthy adults according to one SR, but this was not confirmed by other reviews (GRADE low). Zanamivir showed a preventive effect on antibiotic usage in children (95% (77-99);GRADE moderate) and on the occurrence of bronchitis in at-risk individuals (59% (30-76);GRADE moderate). No evidence was available on the treatment benefits of NIs in elderly and at-risk groups and their effects on hospitalization and mortality. In oseltamivir trials, nausea, vomiting and diarrhea were significant side-effects. For zanamivir trials, no adverse effects have been reported. The combination of diagnostic uncertainty, the risk for virus strain resistance, possible side effects and financial cost outweigh the small benefits of oseltamivir or zanamivir for the prophylaxis and treatment of healthy individuals. No relevant benefits of these NIs on complications in at-risk individuals have been established.
    PLoS ONE 04/2013; 8(4):e60348. DOI:10.1371/journal.pone.0060348 · 3.23 Impact Factor
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    • "Treatment of influenza with neuraminidase inhibitor drugs should be initiated early in the course of disease (Coffin et al., 2011; Fiore et al., 2011; Heinonen et al., 2010; Hernan and Lipsitch, 2011; Kaiser et al., 2003; Treanor et al., 2000; Winther et al., 2010) but is underutilized (Fiore et al., 2011; Louie et al., 2012). Timely diagnosis of influenza is challenging (Hoeven et al., 2007; Talbot and Falsey, 2010), and confirmation of influenza infection by rapid influenza detection test can be helpful ( "
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    ABSTRACT: We evaluated the limits of detection of 3 rapid influenza diagnostic tests-BD Veritor(TM) System for Flu A+B, Binax NOW® Influenza A+B, and QuickVue® Influenza-for influenza strains circulating in 2010-2012. Limits of detection varied by influenza strain, with Veritor(TM) Flu A+B test showing the lowest limit of detection for all strains.
    Diagnostic microbiology and infectious disease 12/2012; 75(2). DOI:10.1016/j.diagmicrobio.2012.11.004 · 2.46 Impact Factor
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