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Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials.
BMJ. 2009 Aug 10; 339:b3172.BMJ

Abstract

OBJECTIVE

To assess the effects of the neuraminidase inhibitors oseltamivir and zanamivir in treatment of children with seasonal influenza and prevention of transmission to children in households.

DESIGN

Systematic review and meta-analysis of data from published and unpublished randomised controlled trials.

DATA SOURCES

Medline and Embase to June 2009, trial registries, and manufacturers and authors of relevant studies. Review methods Eligible studies were randomised controlled trials of neuraminidase inhibitors in children aged </=12 in the community (that is, not admitted to hospital) with confirmed or clinically suspected influenza. Primary outcome measures were time to resolution of illness and incidence of influenza in children living in households with index cases of influenza.

RESULTS

We identified four randomised trials of treatment of influenza (two with oseltamivir, two with zanamivir) involving 1766 children (1243 with confirmed influenza, of whom 55-69% had influenza A), and three randomised trials for postexposure prophylaxis (one with oseltamivir, two with zanamivir) involving 863 children; none of these trials tested efficacy with the current pandemic strain. Treatment trials showed reductions in median time to resolution of symptoms or return to normal activities, or both, of 0.5-1.5 days, which were significant in only two trials. A 10 day course of postexposure prophylaxis with zanamivir or oseltamivir resulted in an 8% (95% confidence interval 5% to 12%) decrease in the incidence of symptomatic influenza. Based on only one trial, oseltamivir did not reduce asthma exacerbations or improve peak flow in children with asthma. Treatment was not associated with reduction in overall use of antibiotics (risk difference -0.30, -0.13 to 0.01). Zanamivir was well tolerated, but oseltamivir was associated with an increased risk of vomiting (0.05, 0.02 to 0.09, number needed to harm=20).

CONCLUSIONS

Neuraminidase inhibitors provide a small benefit by shortening the duration of illness in children with seasonal influenza and reducing household transmission. They have little effect on asthma exacerbations or the use of antibiotics. Their effects on the incidence of serious complications, and on the current A/H1N1 influenza strain remain to be determined.

Authors+Show Affiliations

Kadoorie Centre, John Radcliffe Hospital, Headington, Oxford OX3 9DU.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

19666987

Citation

Shun-Shin, Matthew, et al. "Neuraminidase Inhibitors for Treatment and Prophylaxis of Influenza in Children: Systematic Review and Meta-analysis of Randomised Controlled Trials." BMJ (Clinical Research Ed.), vol. 339, 2009, pp. b3172.
Shun-Shin M, Thompson M, Heneghan C, et al. Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. BMJ. 2009;339:b3172.
Shun-Shin, M., Thompson, M., Heneghan, C., Perera, R., Harnden, A., & Mant, D. (2009). Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. BMJ (Clinical Research Ed.), 339, b3172. https://doi.org/10.1136/bmj.b3172
Shun-Shin M, et al. Neuraminidase Inhibitors for Treatment and Prophylaxis of Influenza in Children: Systematic Review and Meta-analysis of Randomised Controlled Trials. BMJ. 2009 Aug 10;339:b3172. PubMed PMID: 19666987.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. AU - Shun-Shin,Matthew, AU - Thompson,Matthew, AU - Heneghan,Carl, AU - Perera,Rafael, AU - Harnden,Anthony, AU - Mant,David, Y1 - 2009/08/10/ PY - 2009/8/12/entrez PY - 2009/8/12/pubmed PY - 2009/8/29/medline SP - b3172 EP - b3172 JF - BMJ (Clinical research ed.) JO - BMJ VL - 339 N2 - OBJECTIVE: To assess the effects of the neuraminidase inhibitors oseltamivir and zanamivir in treatment of children with seasonal influenza and prevention of transmission to children in households. DESIGN: Systematic review and meta-analysis of data from published and unpublished randomised controlled trials. DATA SOURCES: Medline and Embase to June 2009, trial registries, and manufacturers and authors of relevant studies. Review methods Eligible studies were randomised controlled trials of neuraminidase inhibitors in children aged </=12 in the community (that is, not admitted to hospital) with confirmed or clinically suspected influenza. Primary outcome measures were time to resolution of illness and incidence of influenza in children living in households with index cases of influenza. RESULTS: We identified four randomised trials of treatment of influenza (two with oseltamivir, two with zanamivir) involving 1766 children (1243 with confirmed influenza, of whom 55-69% had influenza A), and three randomised trials for postexposure prophylaxis (one with oseltamivir, two with zanamivir) involving 863 children; none of these trials tested efficacy with the current pandemic strain. Treatment trials showed reductions in median time to resolution of symptoms or return to normal activities, or both, of 0.5-1.5 days, which were significant in only two trials. A 10 day course of postexposure prophylaxis with zanamivir or oseltamivir resulted in an 8% (95% confidence interval 5% to 12%) decrease in the incidence of symptomatic influenza. Based on only one trial, oseltamivir did not reduce asthma exacerbations or improve peak flow in children with asthma. Treatment was not associated with reduction in overall use of antibiotics (risk difference -0.30, -0.13 to 0.01). Zanamivir was well tolerated, but oseltamivir was associated with an increased risk of vomiting (0.05, 0.02 to 0.09, number needed to harm=20). CONCLUSIONS: Neuraminidase inhibitors provide a small benefit by shortening the duration of illness in children with seasonal influenza and reducing household transmission. They have little effect on asthma exacerbations or the use of antibiotics. Their effects on the incidence of serious complications, and on the current A/H1N1 influenza strain remain to be determined. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/19666987/Neuraminidase_inhibitors_for_treatment_and_prophylaxis_of_influenza_in_children:_systematic_review_and_meta_analysis_of_randomised_controlled_trials_ L2 - https://www.bmj.com/lookup/pmidlookup?view=long&amp;pmid=19666987 DB - PRIME DP - Unbound Medicine ER -