ISSN - 0973-0958

Pediatric Oncall Journal

Drug Therapy: Neuraminidase Inhibitors for Influenza 01/10/2014 00:00:00

Drug Therapy: Neuraminidase Inhibitors for Influenza

Vaccination is the primary means for prevention of influenza, however antigenic drift in the virus may render the vaccine less protective and outbreaks can occur more easily among high-risk population. Hence antiviral agents may form an important role in management of this virus.

Four drugs are currently available for management of influenza infection namely:

  • Amantadine } Adamantanes
  • Rimantadine }
  • Oseltamivir }Neuraminidase inhibitors
  • Zanamivir }

The Adamantanes inhibit viral uncoating within the cell, are effective only against influenza, are associated with severe side effects and new strains of H5N1 are already resistant to this class of drugs. Hence they are not recommended for treatment of bird flu.

The neuraminidase inhibitors interfere with release of progeny influenza virus from infected host cells and thus prevent infection of new host cells. Hence, these drugs should be administered as early in the disease cause as possible. They are effective against all neuraminidase subtypes and this effective against all strains of influenza and hence are the drug of choice for the recent bird flu.

Pharmacokinetics :- Zanamivir is not orally effective and is available as a dry powder for inhalation which delivers the drug directly to the respiratory tract. The concentration of the drug in the respiratory tract has been estimated to be more than 1000 times higher than IC 50 (50 percent inhibitory concentration) with action starting within 10 seconds of administration.

Oseltamivir is available as capsule or powder for liquid suspension with good oral absorption. Half life is 6 to 10 hours. The drug is primarily excreted in the kidney. It is useful in extrapulmonary disease manifestation.

Adverse Effects :-
Zanamivir - Cough, bronchospasm and reversible decrease in pulmonary functions.

Oseltamivir - Transient nausea, vomiting and abdominal pain.

Dosage :- See Table 1. oseltamivir dose needs to be adjusted in patients with renal disease.

Table 1: Treatment of BIRD FLU (1)
Drug1-6 years7-12 years> 13 years
Treatment Zanamivir-10 mg twice daily for 5 days10 mg twice daily for 5 days
Oseltamivir75 mg twice daily for 5 days irrespective of weight
< 15kg30 mg twice daily for 5 days30 mg twice daily for 5 days 
15-23 kg45 mg twice daily for 5 days45 mg twice daily for 5 days
23-40 kg60 mg twice daily for 5 days60 mg twice daily for 5 days
> 40 kg75 mg twice daily for 5 days75 mg twice daily for 5 days
Prevention Oseltamivir--75 mg once daily for 7-10 days

Resistance: Resistance though rare with neuraminidase inhibitors has been reported recently with oseltamivir more commonly in children and hence these drugs need to be given with caution to prevent emergence of drug resistance.
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