Neuraminidase inhibitors in pediatric patients: potential place in influenza therapy.

Influenza is responsible for annual epidemics, and is associated with significant morbidity and mortality. The development and use of antiviral agents is one of the recent strategies used to control influenza. Zanamivir and oseltamivir are members of a new class of antiviral agents, the neuraminidase inhibitors, that are effective in the treatment of influenza. These drugs have been evaluated in double-blind, placebo-controlled trials in children. Efficacy was shown by shortened duration of influenza-related symptoms in children treated with neuraminidase inhibitors. Seasonal prophylaxis in adults, and administration to household contacts of influenza-infected persons has decreased the incidence of influenza infection and illness. Adverse effects of zanamivir are minimal, while oseltamivir is associated with gastrointestinal upset, which does not usually require the medication to be ceased. No serious adverse events have been reported in children receiving these medications. Caution should be exercised in the use of zanamivir in children with asthma due to the potential development of bronchospasm and respiratory distress. Development of resistance to these medications is reported to occur less frequently than with amantadine. Resistance to zanamivir has been rarely detected during clinical trials, while up to 5.5% of influenza strains isolated from children after treatment were reported to be resistant to oseltamivir. Due to the role children play in the spread of influenza within the community, use of these medications may help control influenza epidemics.