Neuraminidase inhibitor therapy in a military population

• Published in: Journal of clinical virology Vol. 67; pp. 17 - 22
• Main Authors: Fairchok, Mary P., Chen, Wei-Ju, Arnold, John C., Schofield, Christina, Danaher, Patrick J., McDonough, Erin A., Ottolini, Martin, Mor, Deepika, Ridore, Michelande, Burgess, Timothy H., Millar, Eugene V.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2015
• Subjects: Adolescent; Adult; Aged; Allergy and Immunology; Antiviral Agents - therapeutic use; Antivirals; Child; Child, Preschool; Drug Prescriptions - statistics & numerical data; Drug Utilization; Family Health; Female; Humans; Infant; Infant, Newborn; Infectious Disease; Influenza; Influenza, Human - drug therapy; Influenza, Human - pathology; Male; Middle Aged; Military Personnel; Neuraminidase - antagonists & inhibitors; Neuraminidase inhibitors; Prescription; Prospective Studies; Severity; Treatment Outcome; Young Adult; Prescription; Severity; Neuraminidase inhibitors; Influenza; Antivirals
• ISSN: 1386-6532; 1873-5967
• DOI: 10.1016/j.jcv.2015.03.018

•We report NI prescription patterns and effects on influenza severity in healthy hosts.•NI prescriptions are increasing, but early prescription within 48h is not.•Early prescription of NI modestly reduces the severity of some symptoms in adults.•Early prescription, but not late prescription, reduces the duration of viral shedding. Although neuraminidase inhibitors (NI) are the mainstay of treatment for influenza infection, prescribing practice for these agents is not well described. Additionally, benefit is contested. We examined provider prescriptions of NI during the 2009 pandemic and post-pandemic periods. We also evaluated the effectiveness of NI in reducing severity of influenza infection. Data on NI prescription and severity of influenza infection were compiled in healthy pediatric and adult beneficiaries enrolled in a prospective study of influenza like illness conducted at five military medical centers over five years. Subjects underwent nasal swabs to determine viral etiology of their infection. Demographic, medication and severity data were collected. Subjects with positive influenza were included. Two hundred sixty three subjects were influenza positive [38% [H1N1] pdm09, 38.4% H3N2, and 20.5% B); 23.9% were treated with NI. NI were initiated within 48h in 63% of treated subjects. Although NI use increased over the five years of the study, early use declined. Most measures for severity of illness were not significantly reduced with NI; adults treated within 48h had only a modest reduction in duration and severity of some of their symptoms. NI use in our population is increasing, but early use is not. NI use resulted in no reduction in complications of illness. Resolution of symptoms and reduction in severity of some symptoms were slightly better in adults who were treated early. These modest benefits do not support routine treatment with NI in otherwise healthy individuals with influenza.