Article

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

ABSTRACT

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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    • "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.
    Full-text · Article · Apr 2013 · PLoS ONE
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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 (http://www.cdc.gov/flu/professionals/ "
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    Full-text · Article · Dec 2012 · Diagnostic microbiology and infectious disease
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    • "The 2009 influenza A (H1N1) pandemic provoked large-scale public health responses and implementation of pandemic preparedness plans throughout the world. Clinical trials have shown that neuraminidase inhibitors (NAIs), a class of antiviral drugs including oseltamivir and zanamivir, are efficacious in lowering morbidity related to influenza, reducing both the duration of symptoms from influenza and the overall severity of the illness [1], [2], [3], [4]. Furthermore, modeling studies suggest that treatment of symptomatic individuals with antivirals during a pandemic can reduce the overall disease attack rate and lessen the overall scope of local epidemics [5], [6], [7]. "
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    Full-text · Article · Sep 2012 · PLoS ONE
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