Antiviral therapy of influenza.
Antiviral therapy of influenza.
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DOI：
10.1053/spid.2002.122999
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发表时间：
2002-04-01
期刊：
影响因子：
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通讯作者：
Englund, Janet A
中科院分区：
文献类型：
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作者：
Englund, Janet A
使用疫苗预防流感病毒感染仍然是控制流感病毒最具成本效益和最实用的方法，但在某些人群或高危人群中使用抗病毒预防和治疗也是可能的。目前在美国有四种抗病毒药物获批用于治疗和/或预防儿童流感病毒感染。多年来，M2阻滞剂（金刚烷胺和金刚乙胺）已获准用于预防和治疗包括儿童在内的各种高危人群的流感。这些药物的优点包括低成本，高口服生物利用度，以及其中一种药物（金刚乙胺）在儿童中的相对耐受性。缺点包括仅对A型流感病毒有效（对B型流感病毒无效），耐药性的相对快速发展，特别是与金刚烷胺相关的不良反应（特别是对老年人和肾功能下降的人）。两种新型抗病毒药物，神经氨酸酶抑制剂，最近在美国获准用于流感的治疗和预防。奥司他韦获批用于1岁以上儿童的流感治疗和13岁以上儿童的预防。该药物安全且耐受性良好，可制成胶囊或液体悬浮液。另一种神经氨酸酶抑制剂扎那米韦通过一种特殊的吸入器装置作为吸入粉末给药，并被许可用于治疗7岁以上儿童的流感。两种神经氨酸酶抑制剂似乎同样有效，并且与抗病毒耐药性的发展无关。没有对任何这些抗病毒药物进行直接比较；如果在症状出现的48小时内开始治疗，所有这些治疗均可使其他健康儿童的临床改善大约提前1至2天。
The prevention of influenza virus infections by the use of vaccines remains the most cost-effective and practical method of influenza virus control, but the use of antiviral prophylaxis and treatment in certain populations or high-risk individuals is also possible. Four antiviral drugs are currently licensed in the United States for the treatment and/or prevention of influenza virus infection in children. The M2 blockers, (amantadine and rimantadine) have been licensed for the prophylaxis and treatment of influenza in diverse high-risk populations, including children, for years. Advantages of these agents include the low cost, high oral bioavailability, and relative tolerability of one of these agents (rimantadine) in children. Disadvantages include efficacy against influenza A viruses only (not type B), the relative rapid development of resistance, and adverse effects associated with amantadine in particular (especially in the elderly and those with decreased renal function). Two agents in a new antiviral class, the neuraminidase inhibitors, have been licensed recently for the treatment and prophylaxis of influenza in the United States. Oseltamivir is licensed for the treatment of influenza in children older than 1 year and for the prophylaxis in children older than 13 years. This drug is safe and well-tolerated, and is available in capsules or a liquid suspension. Another neuraminidase inhibitor, zanamivir, is administered as an inhaled powder via a special inhaler device and is licensed for the treatment of influenza in children older than 7 years. Both neuraminidase inhibitors appear to be similarly effective and are not associated with the development of antiviral resistance. No direct comparisons of any of these antiviral agents has been performed; all result in clinical improvement approximately 1 to 2 days earlier in otherwise healthy children when therapy is initiated within 48 hours of onset of symptoms.