Reserve antivirals for pandemic use

Antivirals amantadine (Lysovir or Symmetrel) and rimantadine (Flumadine) should not be used for seasonal flu control because of serious side-effects such as insomnia and hallucinations, according to Italian and Australian researchers.

They advised that zanamivir (Relenza) and oseltamivir (Tamiflu) be used in an epidemic or pandemic scenario.

NICE advises against the use of amantadine but recommends oseltamivir and zanamivir be used if levels of influenza A or B reach more than 50 consultations per 100,000 population in England and Scotland, or more than 25 in Wales.

NICE has not advised on rimantadine use because it is not licensed in the UK.

M2 channel inhibitors amantadine and rimantadine were found to have a symptomatic effect on patients' flu symptoms.

They did not prevent infection or reduce nasal viral shedding.

The neuraminidase inhibitors zanamivir and oseltamivir were found to reduce symptoms. They also reduced transmission of seasonal flu, but did not prevent asymptomatic infection or nasal viral shedding.

The researchers concluded that to prevent resistant flu strains developing, neuraminidase inhibitors should only be used in the event of a serious epidemic or pandemic.

They also reported that there was no credible evidence that oseltamivir could treat avian influenzas, including H5N1.

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