What is the role of antiviral therapy in the treatment of influenza pneumonia?

Updated: Mar 24, 2021
  • Author: Zab Mosenifar, MD, FACP, FCCP; Chief Editor: John J Oppenheimer, MD  more...
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Answer

Antiviral therapy is available for the treatment of influenza virus infection. The treatment of uncomplicated influenza is supportive in nature, consisting of rest and administration of antipyretics and analgesics. See Table 3 below.

Table 3. Characteristics of Anti-Influenza Drugs (Open Table in a new window)

 

Amantadine

(Symmetrel)

Rimantadine

(Flumadine)

Zanamivir

(Relenza)

Oseltamivir

(Tamiflu)

Mechanism of action

M2 ion channel blockade inhibits HAa cleavage beta block RNA encoding, which reduces early viral replication.

Viral NAb inhibition prevents sialic acid cleavage from HA beta virus gets trapped inside cells, and epithelial spread is blocked.

Spectrum

Influenza A only

Influenza A only

Influenza A and B

Influenza A and B

Oral bioavailability

Good

Good

Poor

Good

Protein binding, %

67

40

None

Minimal

Half-life, h

12-18

24-36

2.5-5

1-3

Excretion

Renal (not removed by hemodialysis)

 

Renal and gastrointestinal

Renal

Drug interaction

Synergistic CNS toxicity with antihistamines, anticholinergics, CNS stimulants

Beta Plasma level: ASAc, acetaminophen

None

None

Renal clearance

TMP-SMZd, triamterene, hydrochlorothiazide, quinine sulfate, quinidine

Cimetidine

None

None

a HA - Hemagglutinin

b NA - Neuraminidase

c ASA - Acetylsalicylic acid

d TMP-SMZ - Trimethoprim and sulfamethoxazole


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