An assessment of the antiviral treatment against the flu in 2001

Introduction. - The availability of new neuraminidase inhibitors which inte ract on the influenza A and B viruses could be the start of a new approach to flu treatment. Until now, vaccination has been the principal medical tre atment, except in the case of a pandemic caused by antigenic shifts. In thi s article the authors will answer the following questions: Potentially, is there room for antiviral drugs and why? Are these drugs efficient and accor ding to which criteria? Who are they for? And what indications must be foll owed? Are they well tolerated? Do they induce any viral resistance? M2 prot ein inhibitors (i.e., amantadine and rimantadine) are compared with neurami nidase inhibitors (i.e., zanamivir and oseltamivir). Current knowledge and key points. - Neuraminidase inhibitors prescribed dur ing the first 48 h have a medical curative effectiveness on non-complicated forms carried by healthy patients - symptoms last no longer than 1 to 3 da ys and their severity is reduced. This efficiency could potentially concern unexpected complications due to the diminution of antibiotics absorption. The inhibitors seem to induce little resistance and are responsive to influ enza B as opposed to the M2 protein inhibitors. They seem to be well-tolera ted by patients and they are also efficient when it comes to prophylaxis me asures. Future prospects and projects. - It is assumed that these treatments are us ed in a curative and preventive manner in order to give them their full str ategic importance (their use is currently forbidden in France). This import ance will require that physicians and the population be well aware of the e pidemic and that responsive physicians who know the medical indications qui ckly implement the treatment. It is necessary to carry out surveys with tho se at risk who are seriously ill with the flu in order to measure ratios su ch as cost efficiency. The use of these treatments will have to be evaluate d, bearing special attention on the risks of the emergence of resistant vir uses and on the impact on vaccination. (C) 2001 Editions scientifiques et m edicales Elsevier SAS.