Giuseppe
Emeritus
Abstract. Influenza Virus Resistance to Antiviral Agents: A Plea for Rational Use.
Clinical Infectious Diseases 2009;48:000?000
? 2009 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2009/4809-00XX$15.00
DOI: 10.1086/598989
VIEWPOINTS
Influenza Virus Resistance to Antiviral Agents: A Plea for Rational Use
Gregory A. Poland,1,2,3,4 Robert M. Jacobson,1,3 and Inna G. Ovsyannikova1,2,4
1Mayo Vaccine Research Group, Departments of 2Internal Medicine and 3Pediatric and Adolescent Medicine, and 4Program in Translational Immunovirology and Biodefense, Mayo Clinic, Rochester, Minnesota
Although influenza vaccine can prevent influenza virus infection, the only therapeutic options to treat influenza virus infection are antiviral agents. At the current time, nearly all influenza A/H3N2 viruses and a percentage of influenza A/H1N1 viruses are adamantane resistant, which leaves only neuraminidase inhibitors available for treatment of infection with these viruses.
In December 2008, the Centers for Disease Control and Prevention released new data demonstrating that a high percentage of circulating influenza A/H1N1 viruses are now resistant to oseltamivir.
In addition, oseltamivir‐resistant influenza B and A/H5N1 viruses have been identified.
Thus, use of monotherapy for influenza virus infection is irrational and may contribute to mutational pressure for further selection of antiviral‐resistant strains. History has demonstrated that monotherapy for influenza virus infection leads to resistance, resulting in the use of a new monotherapy agent followed by resistance to that new agent and thus resulting in a background of viruses resistant to both drugs.
We argue that combination antiviral therapy, new guidelines for indications for treatment, point‐of‐care diagnostic testing, and a universal influenza vaccination recommendation are critical to protecting the population against influenza virus and to preserving the benefits of antiviral agents.
Received 31 December 2008; accepted 7 March 2009; electronically published 26 March 2009.
Reprints or correspondence: Dr. Gregory A. Poland, Mayo Vaccine Research Group, Mayo Clinic, 611C Guggenheim Bldg., 200 First St. SW, Rochester, MN 55905 (poland.gregory@mayo.edu).
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<cite cite="http://www.journals.uchicago.edu/doi/abs/10.1086/598989">Chicago Journals - Clinical Infectious Diseases</cite>? 2009 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2009/4809-00XX$15.00
DOI: 10.1086/598989
VIEWPOINTS
Influenza Virus Resistance to Antiviral Agents: A Plea for Rational Use
Gregory A. Poland,1,2,3,4 Robert M. Jacobson,1,3 and Inna G. Ovsyannikova1,2,4
1Mayo Vaccine Research Group, Departments of 2Internal Medicine and 3Pediatric and Adolescent Medicine, and 4Program in Translational Immunovirology and Biodefense, Mayo Clinic, Rochester, Minnesota
Although influenza vaccine can prevent influenza virus infection, the only therapeutic options to treat influenza virus infection are antiviral agents. At the current time, nearly all influenza A/H3N2 viruses and a percentage of influenza A/H1N1 viruses are adamantane resistant, which leaves only neuraminidase inhibitors available for treatment of infection with these viruses.
In December 2008, the Centers for Disease Control and Prevention released new data demonstrating that a high percentage of circulating influenza A/H1N1 viruses are now resistant to oseltamivir.
In addition, oseltamivir‐resistant influenza B and A/H5N1 viruses have been identified.
Thus, use of monotherapy for influenza virus infection is irrational and may contribute to mutational pressure for further selection of antiviral‐resistant strains. History has demonstrated that monotherapy for influenza virus infection leads to resistance, resulting in the use of a new monotherapy agent followed by resistance to that new agent and thus resulting in a background of viruses resistant to both drugs.
We argue that combination antiviral therapy, new guidelines for indications for treatment, point‐of‐care diagnostic testing, and a universal influenza vaccination recommendation are critical to protecting the population against influenza virus and to preserving the benefits of antiviral agents.
Received 31 December 2008; accepted 7 March 2009; electronically published 26 March 2009.
Reprints or correspondence: Dr. Gregory A. Poland, Mayo Vaccine Research Group, Mayo Clinic, 611C Guggenheim Bldg., 200 First St. SW, Rochester, MN 55905 (poland.gregory@mayo.edu).
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