Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
Paediatr Drugs. 2010 Oct 1;12(5):285-99. doi: 10.2165/11532530-000000000-00000.
Influenza infection is annually responsible for significant morbidity and mortality, particularly among the very young and old. Recently updated guidelines recommend influenza vaccination of all children aged 6 months to 18 years; however, childhood vaccination remains underutilized. Furthermore, concerns over the reduced efficacy of vaccination in children have further heightened the need for effective treatment schemes. Antiviral therapies have emerged as attractive options in the battle against influenza infection. These agents include the adamantanes (amantadine and rimantadine) and neuraminidase inhibitors (zanamivir, oseltamivir, and peramivir). Broad-scale use of adamantane antivirals has been severely limited in recent years because of high resistance rates and their inability to cover influenza type B. Neuraminidase inhibitors cover influenza types A and B, and have been promulgated to first-line therapy because of historically low resistance rates and relatively infrequent side effects. Moreover, these agents are effective options in combating non-seasonal influenza strains, including H5N1 and pandemic 2009 H1N1. Oseltamivir may be particularly appealing for treating children since it is available in multiple oral dosage formulations, whereas commercially available zanamivir use is limited in young children because it requires inhalation. However, the emergence of resistance to oseltamivir among influenza A strains may limit its usefulness. Additional concerns with neuraminidase inhibitor use in pediatrics center around emerging reports, primarily from Japan, that have temporally linked oseltamivir to significant neuropsychiatric events in children of varying ages. Numerous novel antiviral agents are under development, but most are far from market approval. In addition to treating and preventing the initial burden of pediatric influenza infection, antiviral therapies may significantly reduce secondary bacterial infections (including pneumonia and otitis media), unnecessary antibiotic prescribing, and healthcare-associated costs.
流感感染每年都会导致大量发病率和死亡率，尤其是在非常年幼和年老的人群中。最近更新的指南建议对所有 6 个月至 18 岁的儿童进行流感疫苗接种；然而，儿童疫苗接种的利用率仍然较低。此外，人们对疫苗在儿童中的效果降低的担忧进一步加剧了对有效治疗方案的需求。抗病毒疗法已成为对抗流感感染的有吸引力的选择。这些药物包括金刚烷胺（金刚烷胺和金刚乙胺）和神经氨酸酶抑制剂（扎那米韦、奥司他韦和帕拉米韦）。由于高耐药率和无法覆盖乙型流感，近年来广泛使用的金刚烷胺抗病毒药物已受到严重限制。神经氨酸酶抑制剂覆盖了甲型和乙型流感，并且由于历史上耐药率低且副作用相对较少，已被推广为一线治疗药物。此外，这些药物是对抗非季节性流感株（包括 H5N1 和 2009 年大流行的 H1N1）的有效选择。奥司他韦可能特别适合治疗儿童，因为它有多种口服剂型，而市售的扎那米韦在幼儿中的应用有限，因为它需要吸入。然而，流感 A 株对奥司他韦的耐药性的出现可能会限制其用途。神经氨酸酶抑制剂在儿科中的应用的其他关注点是主要来自日本的新出现的报告，这些报告将奥司他韦与不同年龄段儿童的重大神经精神事件在时间上联系起来。许多新的抗病毒药物正在开发中，但大多数都远未获得市场批准。除了治疗和预防儿童流感感染的初始负担外，抗病毒疗法还可能显著减少继发性细菌感染（包括肺炎和中耳炎）、不必要的抗生素处方和与医疗保健相关的成本。
