Iain Stephenson1, Tristan W Clark, Manish Pareek. 1. Infectious Diseases Unit, Level 6, Windsor Building, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom. iain.stephenson@uhl.tr.nhs.uk
Abstract
BACKGROUND: Specific anti-influenza drugs are available for the management of seasonal influenza. OBJECTIVES: To evaluate European recommendations and guidelines for the use of antiviral drugs in treatment and prevention of seasonal influenza. DESIGN: Guidelines issued between January 2003 and September 2007 were scored using the AGREE appraisal instrument and evaluated. RESULTS: Guidelines were obtained from France, Germany, Italy, Netherlands, Poland, Portugal, Sweden and the UK. Most guidelines recommend neuraminidase inhibitors over M2 inhibitors, but three countries were unclear or suggested M2 inhibitor use in some circumstances. Clinical diagnosis of patients eligible for treatment during periods of influenza activity is acceptable except in Poland where virological confirmation is required. Guidelines recommend antiviral use in patients at high risk of complications, except in Germany where there is a strong recommendation to treat all patients. Post-exposure prophylaxis for household contacts is recommended in Sweden and Germany, but not other countries. Only UK guidelines are regularly updated. All scored fairly poorly by the AGREE instrument. French, Polish, Swedish and UK guidelines were recommended. CONCLUSION: Major variations exist in recommendations for treatment and prevention of seasonal influenza. Development of Pan-European guidance should be considered. Updating is important to reflect emerging patterns of antiviral resistance.
BACKGROUND: Specific anti-influenza drugs are available for the management of seasonal influenza. OBJECTIVES: To evaluate European recommendations and guidelines for the use of antiviral drugs in treatment and prevention of seasonal influenza. DESIGN: Guidelines issued between January 2003 and September 2007 were scored using the AGREE appraisal instrument and evaluated. RESULTS: Guidelines were obtained from France, Germany, Italy, Netherlands, Poland, Portugal, Sweden and the UK. Most guidelines recommend neuraminidase inhibitors over M2 inhibitors, but three countries were unclear or suggested M2 inhibitor use in some circumstances. Clinical diagnosis of patients eligible for treatment during periods of influenza activity is acceptable except in Poland where virological confirmation is required. Guidelines recommend antiviral use in patients at high risk of complications, except in Germany where there is a strong recommendation to treat all patients. Post-exposure prophylaxis for household contacts is recommended in Sweden and Germany, but not other countries. Only UK guidelines are regularly updated. All scored fairly poorly by the AGREE instrument. French, Polish, Swedish and UK guidelines were recommended. CONCLUSION: Major variations exist in recommendations for treatment and prevention of seasonal influenza. Development of Pan-European guidance should be considered. Updating is important to reflect emerging patterns of antiviral resistance.
Authors: Emily Bongard; Alike W van der Velden; Johanna Cook; Ben Saville; Philippe Beutels; Rune Munck Aabenhus; Curt Brugman; Slawomir Chlabicz; Samuel Coenen; Annelies Colliers; Melanie Davies; Muireann De Paor; An De Sutter; Nick A Francis; Dominik Glinz; Maciek Godycki-Ćwirko; Herman Goossens; Jane Holmes; Margareta Ieven; Menno de Jong; Morten Lindbaek; Paul Little; Frederico Martinón-Torres; Ana Moragas; József Pauer; Markéta Pfeiferová; Ruta Radzeviciene-Jurgute; Pär-Daniel Sundvall; Antoni Torres; Pia Touboul; Dionyssios Varthalis; Theo Verheij; Christopher C Butler Journal: BMJ Open Date: 2018-07-12 Impact factor: 2.692