Clinical Question by what means ...

Clinical Question

by what means safe, effective, and tolerable are oseltamivir and zanamivir in the treatment of children with influenza?

Evidence-Based Answer

Oseltamivir and zanamivir bring into the duration of illness through up to one day if taken within 36 hours of symptom attack Oseltamivir (and, probably, zanamivir) also decreases the likelihood of otitis media as a complication of influenza (number wanted to treat, approximately 10). There were no data onward the medications' efficacy in preventing influenza. the couple medications are well tolerated and safe.

Practice Pointers

sum of two units neuraminidase inhibitors, oseltamivir and zanamivir, are approved for use in children. Oseltamivir, which is approved for use in children older then individual year, is taken twice daily for five days in dosages of 30 mg (in children weighing les than 15 kg) 45 mg (in children 15 to 22 kg) 60 mg (in children 23 to 40 kg) or 75 mg (in children more than 40 kg) Oseltamivir outlays $33 to $67 per treatment course, depending forward the dosage. (Prices represent estimated splendor to the pharmacist based in succession average wholesale prices in R book.Montvale, N.J.:Medical Economics Data, 2004 costliness to the patient will be higher, depending in succession prescription filling fee.)

Zanamivir, an inhaled agent approved for use in children older than seven years, is taken as sum of two units puffs every 12 hours for five days and prices $50 per course. Patients must begin taking oseltamivir or zanamivir within 36 hours of symptom onset

Matheson and colleagues identified three double-blinded, randomized, placebo-controlled trials of 1500 children with a clinical diagnosis of influenza (i.e., heat and at least two of the following symptoms: cough headache, myalgia, sore throat, fatigue). In approximately 53 percent of the children, influenza was eventually confirmed at laboratory tests.

In the 1500 children with clinically diagnosed influenza, oseltamivir reduc symptoms by the agency of a mean of 21 hours, and zanamivir reduc symptoms by means of a mean of 12 hours. In children with laboratory-confirmed influenza, oseltamivir and zanamivir reduc symptoms according to 36 and 30 hours, respectively. In children with asthma and laboratory-confirmed influenza, the duration of illness was reduc by dint of only 10 hours (P = NS)

Oseltamivir reduc the likelihood of acute otitis media from 28 to 17 percent (P = 005) and of bronchitis from 21 to 12 percent (P<05) Zanamivir use was associated with a nonsignificant reduction in the likelihood of otitis media (23 to 16 percent P = NS)

Although vomiting was more often met with in children taking zanamivir (15 percent versus 9 percent in children taking oseltamivir), the two drugs were well tolerated, with loched withdrawal rates similar to those of placebo.

MARK H EBELL, MD MS

Matheson NJ et al. Neuraminidase inhibitors for preventing and treating influenza in children. Cochrane Database Syst Rev 2003;3:CD002744

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