Chan Ken K P, Hui David S C
Division of Respiratory Medicine, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
Curr Opin Infect Dis. 2023 Apr 1;36(2):124-131. doi: 10.1097/QCO.0000000000000910. Epub 2023 Jan 30.
The heavily suppressed global influenza activity during the coronavirus disease 2019 (COVID-19) pandemic is expected to return upon relaxation of travel restriction and nonpharmaceutical interventions (NPI). We reviewed the four marketed neuraminidase inhibitors (NAI e.g., oseltamivir, zanamivir, peramivir, laninamivir) and the only endonuclease inhibitor (baloxavir) on their clinical therapeutic effects and the ability of viral suppression in various groups of patients of different clinical settings based on the latest evidence.
Early initiation, preferably within 48 h of symptom onsets, of antiviral treatments with NAI and baloxavir, is crucial to produce favourable outcomes in patients with influenza infection. Updated evidence does not suggest routine use of combined antiviral agents in patients with influenza infection. Treatment-emergent resistant influenza variants may occur during NAI and baloxavir use, but it has no major impact on subsequent recovery. Early treatment of index patients with influenza infection and post-exposure prophylaxis in specific populations is crucial in preventing influenza transmission.
Antiviral therapy is the major defence therapeutically in the community and hospital settings to expedite early recovery and reduce influenza-related complications. Early treatment of index patients and post-exposure prophylaxis in susceptible close contacts may mitigate the spread of infection.
在2019冠状病毒病（COVID-19）大流行期间受到严重抑制的全球流感活动，预计在旅行限制和非药物干预（NPI）放松后将会恢复。我们根据最新证据，综述了四种已上市的神经氨酸酶抑制剂（NAI，如奥司他韦、扎那米韦、帕拉米韦、拉尼米韦）和唯一的核酸内切酶抑制剂（巴洛沙韦）在不同临床环境的各类患者中的临床治疗效果及病毒抑制能力。
对于流感感染患者，尽早开始抗病毒治疗，最好在症状出现后48小时内使用NAI和巴洛沙韦，对于取得良好治疗效果至关重要。最新证据并不建议对流感感染患者常规使用联合抗病毒药物。在使用NAI和巴洛沙韦期间可能会出现治疗中出现的耐药流感变异株，但对随后的康复没有重大影响。对流感感染的索引病例进行早期治疗以及在特定人群中进行暴露后预防对于预防流感传播至关重要。
抗病毒治疗是社区和医院环境中促进早期康复和减少流感相关并发症的主要治疗手段。对索引病例进行早期治疗以及对易感密切接触者进行暴露后预防可能会减轻感染传播。
