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Emerging resistance threatens influenza control.(Clinical Rounds)
Evidence of widespread resistance of influenza to amantadine and rimantadine has prompted calls for restraint in antiviral use in order to preserve the therapeutic value of these adamantanes as well as newer generation agents.
Investigators at the Centers for Disease Control and Prevention detected an "alarmingly high" resistance rate of 92% to amantadine and rimantadine in an analysis of 209 influenza A(H3N2) isolates from patients in 26 states from Oct. 1 through Dec. 31, 2005 (JAMA doi:10.1001/jama.295.8.joc60020, published Feb. 2, 2006).
An earlier CDC analysis that found adamantane resistance in 109 of 120 influenza A(H3N2) isolates from patients in 23 states from Oct. 1, 2005, through Jan. 12, 2006, led the CDC to issue a Health Alert on Jan. 14, 2006. The alert recommended against the use of amantadine or rimantadine for treatment or prophylaxis of influenza A infections in the United States for the rest of the 2005-2006 flu season.
"If antiviral use is curtailed, susceptible strains could emerge and adamantanes could regain their utility against both epidemic and pandemic influenza," Dr. David M. Weinstock and Dr. Gianna Zuccotti of Memorial Sloan-Kettering Cancer Center, New York, wrote in an editorial (JAMA doi: 10.1001/jama.295.8.jed60009, published Feb. 2, 2006).
In the report, Rick A. Bright, Ph.D., and his colleagues at the CDC noted that adamantane resistance in the United States increased from 1.9% in 2003-2004 to 11% in 2004-2005 to the current rate of 92%.
The CDC study also noted that 100% of influenza A(H3N2) isolates from 10 patients in Mexico and 3 patients in Canada were resistant to amantadine and rimantadine. A recent report on influenza A(H3N2) isolates from the 2005-2006 influenza season in Canada found that 43 (91%) of 47 isolates showed resistance to those drugs.
In a related report that appeared just before the CDC report, a systematic review of 52 randomized, controlled trials of the adamantanes and the newer generation neuraminidase inhibitors oseltamivir (Tam-iflu) and zanamivir (Relenza) also raised serious doubts about using the four drugs for the routine control of seasonal influenza.
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Source: HighBeam Research, Emerging resistance threatens influenza control.(Clinical Rounds)