If H274Y takes hold and takes out both tamiflu and peramivir it does seem that for all practical purposes we would be left with inhaled Relenza (and its inherent problems of being able to be inhaled deep enough in young children and in people with lung problems)... 2 other drugs in the pipeline A-315675 (a possible oral alternative to tamiflu) and long acting zanamivir dimers also both look like they have their problems in development .. A-315675 though may be worth some clinical trials as it appears to have some effectiveness against H274Y although it appears difficult to sort out its in vitro and in vivo effectiveness (in mice)...
http://www.sciencedirect.com/scienc...serid=10&md5=30c45280c3e0da047dde530560201c11
""These results confirm the potent inhibitory effect of A-315675 against oseltamivir-resistant influenza viruses of the N1 and N2 subtypes and support the clinical development of its bioavailable prodrug A-322278.""
http://aac.asm.org/cgi/content/full/53/2/791
"""Finally, we confirmed that the A/H1N1 H274Y mutant virus is as virulent as the WT virus, at least in this mouse model and in the A/WSN/33 background (2), which correlates with its natural occurrence and high transmissibility in humans during the 2007 to 2008 influenza season. Of note, A-322278 appears to be somewhat less effective in protecting mice challenged with the NA H274Y mutant virus than those infected with the WT virus. As we have previously reported similar 50% lethal dose values for the two viruses in mice (i.e., 103 PFU) (2), it is possible that such differences in activity could be attributable to low-level cross-resistance between the two drugs that is not measurable in in vitro assays. Clinical trials of A-322278 are warranted in the context of an eventual pandemic and in consideration of the limited alternatives to oseltamivir. """
