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. 2015 Jun:67:17-22.
doi: 10.1016/j.jcv.2015.03.018. Epub 2015 Mar 24.

Neuraminidase inhibitor therapy in a military population

Mary P Fairchok  1 , Wei-Ju Chen  2 , John C Arnold  3 , Christina Schofield  4 , Patrick J Danaher  5 , Erin A McDonough  6 , Martin Ottolini  7 , Deepika Mor  2 , Michelande Ridore  2 , Timothy H Burgess  8 , Eugene V Millar  2
Affiliations

Neuraminidase inhibitor therapy in a military population

Mary P Fairchok et al. J Clin Virol. 2015 Jun.

Abstract

Background: 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.

Objectives: 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.

Study design: 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.

Results: 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.

Conclusions: 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.

Keywords: Antivirals; Influenza; Neuraminidase inhibitors; Prescription; Severity.

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Conflict of interest statement

CONFLICT OF INTEREST

Competing interests: All authors. None reported.

Figures

Figure 1
Figure 1
Proportion of antiviral usage among patients infected with three flu types, by season. Red: Early antiviral prescription; Blue: Late antiviral prescription; Gray: No antiviral prescription
Figure 2
Figure 2
Daily median and interquartile range of composite symptom scores among influenza-positive adults in the first 7 days of illness, by timing of antiviral drug prescription Red: Early antiviral prescription; Blue: Late antiviral prescription; Gray: No antiviral prescription *: p<0.05 comparing EARLY to LATE use ⱡ: p<0.05 comparing EVER to NEVER use
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