Influenza virus resistance to antiviral agents: a plea for rational use.
Influenza virus resistance to antiviral agents: a plea for rational use.
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DOI：
10.1086/598989
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发表时间：
2009-05-01
期刊：
影响因子：
--
通讯作者：
Ovsyannikova IG
中科院分区：
文献类型：
--
作者：
Poland GA;Jacobson RM;Ovsyannikova IG
虽然流感疫苗可以预防流感病毒感染，但治疗流感病毒感染的唯一治疗选择是抗病毒药物。目前，几乎所有甲型/H3N2 流感病毒和一定比例的甲型/H1N1 流感病毒都具有金刚烷耐药性，这使得只有神经氨酸酶抑制剂可用于治疗这些病毒的感染。 2008年12月，美国疾病控制与预防中心发布的新数据表明，目前流行的甲型/H1N1流感病毒中有很大一部分对奥司他韦具有耐药性。此外，还发现了对奥司他韦具有耐药性的 B 型和 A/H5N1 流感病毒。因此，使用单一疗法治疗流感病毒感染是不合理的，并且可能会导致进一步选择抗病毒耐药株的突变压力。历史证明，流感病毒感染的单一疗法会导致耐药性，导致使用新的单一疗法药物，随后对该新药物产生耐药性，从而导致病毒对两种药物产生耐药性。我们认为，联合抗病毒治疗、治疗适应症的新指南、即时诊断测试和普遍的流感疫苗接种建议对于保护人群免受流感病毒的侵害和保持抗病毒药物的益处至关重要。
Although influenza vaccine can prevent influenza virus infection, the only therapeutic options to treat influenza virus infection are antiviral agents. At the current time, nearly all influenza A/H3N2 viruses and a percentage of influenza A/H1N1 viruses are adamantane resistant, which leaves only neuraminidase inhibitors available for treatment of infection with these viruses. In December 2008, the Centers for Disease Control and Prevention released new data demonstrating that a high percentage of circulating influenza A/H1N1 viruses are now resistant to oseltamivir. In addition, oseltamivir-resistant influenza B and A/H5N1 viruses have been identified. Thus, use of monotherapy for influenza virus infection is irrational and may contribute to mutational pressure for further selection of antiviral-resistant strains. History has demonstrated that monotherapy for influenza virus infection leads to resistance, resulting in the use of a new monotherapy agent followed by resistance to that new agent and thus resulting in a background of viruses resistant to both drugs. We argue that combination antiviral therapy, new guidelines for indications for treatment, point-of-care diagnostic testing, and a universal influenza vaccination recommendation are critical to protecting the population against influenza virus and to preserving the benefits of antiviral agents.
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