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Review

Oseltamivir for influenza infection in children: risks and benefits

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References

•This review describes the attempts to modify the composition or the route of administration of the inactivated influenza vaccine in pediatric population in order to increase the protective efficacy against influenza

•• A review that showed how in recent years there has been much debate and controversy surrounding the efficacy and safety of neuraminidase inhibitors for influenza, in part because the data underlying certain efficacy claims were not available for independent scrutiny. After a protracted campaign to obtain the reports, the manufacturers of the medications provided them unconditionally. The review authors subsequently published the underlying documents simultaneously with the Cochrane review, endorsing the concept of open science

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•A report showing that prolonged treatment of an immunocompromised child with oseltamivir and zanamivir for A(H1N1)pdm09 virus infection led to the emergence of viruses carrying H275Y and/or E119G in the neuraminidase. When phenotypically evaluated by NA inhibition, the dual H275Y-E119G substitution caused highly reduced inhibition by four NA inhibitors: oseltamivir, zanamivir, peramivir, and laninamivir

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•In this meta-analysis, the authors showed that compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk. Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality. Early treatment versus no treatment was also associated with a reduction in mortality. These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day’s delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset

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•By use of flow cytometric analyses and the mouse model, this study demonstrated that antiviral treatment affects the development of the adaptive immune response and protective immunity against influenza

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•In this prospective open-label observational safety study, children aged ≤24 months with a clinical diagnosis of influenza in routine practice received either no antiviral treatment or oseltamivir treatment or prophylaxis, according to the physician’s judgment. Adverse events were analyzed in 1065 patients and it was shown that oseltamivir has a good tolerability profile in this population

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•In this prospective, observational, non-randomized study, infants aged <1 year with laboratory-confirmed influenza were treated with oral oseltamivir for 5 days with twice-daily dosages of 3, 2.5 and 2 mg/kg. Authors showed that oseltamivir dosages of 2–3 mg/kg were well tolerated in infants aged <1 year and achieved therapeutic exposure levels

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