Role of combination antiviral therapy in pandemic influenza and stockpiling implications

doi:10.1136/bmj.39105.428981.BE

BMJ 2007;334:293-294 (10 February), doi:10.1136/bmj.39105.428981.BE

Analysis

Role of combination antiviral therapy in pandemic influenza and stockpiling implications

Sotirios Tsiodras, lecturer in infectious diseases¹, John D Mooney, public health specialist trainee², Angelos Hatzakis, professor³

¹ Fourth Academic Department of Internal Medicine, University of Athens Medical School, Athens 12462, Greece, ² South West Public Health Training Programme, Dorset, ³ Department of Hygiene and Epidemiology, University of Athens Medical School

Correspondence to: S Tsiodras tsiodras@med.uoa.gr

It is impossible to predict which drugs will be effective againsta new pandemic strain of influenza. Sotirios Tsiodras and colleagues argue that failure to stockpile both majorclasses of antiviral drugs could prove costly

The first 150 words of the full text of this article appear below.

We currently have two classes of drugs thatare effective against influenza viruses: the M2 ion channelinhibitors (amantadine and rimantadine) and the neuraminidaseinhibitors (oseltamivir, zanamivir).¹ Although ion channel inhibitorsare effective against several subtypes of influenza A viruses,²they are not being widely stockpiled for a future influenzapandemic.³ This is because they cause unacceptable side effects¹and their use is associated with a rapid emergence of resistance¹ ⁴ ⁵ without any demonstrablereduction in transmissibility or pathogenicity.⁶ Resistanceof influenza A viruses to amantadine is increasing worldwide,⁷and the US Centers for Disease Control and Prevention recommendedagainst the use of ion channel inhibitors for treatment or prophylaxisduring the 2005-6 influenza season.⁸ Policy makers and somemedical experts thus consider ion channel inhibitors inappropriateas first line treatment or prophylaxis for pandemic influenza.We believe their role should be reconsidered for three reasons:firstly, the unpredictability of antiviral . . . [Full text of this article]

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