Ferraris O, Escuret V, Bouscambert-Duchamp M, Lina B, Morfin F
Virologie et pathologie humaine, CNRS FRE 3011, université de Lyon, université Lyon-1, 7, rue Guillaume-Paradin, 69372 Lyon cedex 08, France.
Pathol Biol (Paris). 2010 Apr;58(2):e69-78. doi: 10.1016/j.patbio.2010.01.011. Epub 2010 Mar 19.
Oseltamivir and zanamivir are two neuraminidase inhibitors (NAIs) active on A and B influenza viruses. These analogues have been developed from the structure of sialic acid, the neuraminidase (NA) substrate. Resistance to NAIs have been detected. They are mainly associated to mutations located on the NA gene. The use of these antiviral drugs remains low in the context of seasonal flu, even the duration of symptoms can be reduced of one day if an antiviral treatment is started within 48 hours after disease onset. NAIs also present a significant effect when used in postexposition prophylaxis. Resistance, mainly to oseltamivir, have been detected but remained rare until the spontaneous emergence in 2007-2008 winter of a seasonal A(H1N1) variant resistant to this drug. NAIs are also interesting for the treatment of severe flu infections, specially those associated to A(H5N1). Finally, because of the pandemic A(H1N1)2009 virus, NAIs use has largely increased for prophylactic and therapeutic treatment of severe and non severe infections. This large use may be associated to an increased risk of selection of resistant viruses. Up to now, this phenomenon remains fortunately limited but has to be closely monitored.
奥司他韦和扎那米韦是两种对甲型和乙型流感病毒有效的神经氨酸酶抑制剂（NAIs）。这些类似物是从神经氨酸酶（NA）的底物唾液酸的结构发展而来的。已检测到对NAIs的耐药性。它们主要与位于NA基因上的突变有关。在季节性流感的情况下，这些抗病毒药物的使用仍然很少，即使在疾病发作后48小时内开始抗病毒治疗，症状持续时间也可缩短一天。NAIs在暴露后预防中也有显著效果。已检测到耐药性，主要是对奥司他韦的耐药性，但直到2007 - 2008年冬季季节性甲型H1N1变体对该药物自发出现耐药之前，耐药情况仍然很少见。NAIs对治疗严重流感感染也很有意义，特别是那些与甲型H5N1相关的感染。最后，由于2009年甲型H1N1大流行病毒，NAIs在严重和非严重感染的预防和治疗中的使用大幅增加。这种大量使用可能与选择耐药病毒的风险增加有关。幸运的是，到目前为止，这种现象仍然有限，但必须密切监测。
