Clinical Question: Are antivirals effective in preventing or treating healthy adults with influenza?
Antiviral agents are only slightly effective in preventing confirmed influenza or flu-like illness. When given in the first few days of illness, the M2 ion blockers and neuraminidase inhibitors reduce the duration of illness by approximately 1 day. (LOE = 1a)
These authors searched multiple databases for randomized controlled trials of antiviral medications in treating healthy adults aged 16 years to 65 years with influenza. Additionally, they sought unpublished studies. Two authors independently assessed which studies to include and assessed the quality of the included studies. A third member of the team refereed discrepancies. They analyzed 20 prophylaxis studies and 13 treatment trials using M2 ion blockers: amantidine (Symmetrel) and rimantidine (Flumadine). Additionally they analyzed 19 studies of the neuraminidase inhibitors zanamivir (Relenza) and oseltamivir (Tamiflu): prophylaxis, treatment, and postexposure prophylaxis. In the prophylaxis studies, amantidine prevented 61% of influenza A cases, but only 25% of flu-like illnesses. Adverse effects caused more patients to stop taking amantidine than placebo. Rimantidine was no better than placebo in preventing influenza and flu-like illness, and was also more likely to cause adverse effects that resulted in medication cessation. The neuraminidase inhibitors were no better than placebo in prophylaxis against flu-like illness. Oseltamivir prevents 54% of influenza cases and zanamivir 43%. In a single study, the neuraminidase inhibitors prevented lower respiratory tract infections in confirmed influenza cases but not in flu-like illnesses. The authors were unable to find any rigorous studies of oseltamivir on avian influenza. Unfortunately, the authors don’t provide enough detail to calculate numbers needed to treat or numbers needed to treat to harm.