title: Antivirals against enteroviruses: a critical review from a public-health perspective.
abstract: The enteroviruses (EVs) of the Picornaviridae family are the most common viral pathogens known. Most EV infections are mild and self-limiting but manifestations can be severe in children and immunodeficient individuals. Antiviral development is actively pursued to benefit these high-risk patients and, given the alarming problem of antimicrobial drug resistance, antiviral drug resistance is a public-health concern. Picornavirus antivirals can be used off-label or as part of outbreak control measures. They may be used in the final stages of poliovirus eradication and to mitigate EV-A71 outbreaks. We review the potential emergence of drug-resistant strains and their impact on EV transmission and endemic circulation. We include non-picornavirus antivirals that inhibit EV replication, for example, ribavirin, a treatment for infection with HCV, and amantadine, a treatment for influenza A. They may have spurred resistance emergence in HCV or influenza A patients who are unknowingly coinfected with EV. The public-health challenge is always to find a balance between individual benefit and the long-term health of the larger population.
authors: Centre for Infectious Diseases Research, Diagnostics and Screening, National Institute for Public Health and the Environment, Bilthoven, the Netherlands. k.s.m.benschop@gmail.com.
authors: Kimberley S M
authors: KS
authors: Benschop
authors: Harrie G A M
authors: HG
authors: van der Avoort
authors: Erwin
authors: E
authors: Duizer
authors: Marion P G
authors: MP
authors: Koopmans
mesh_terms: D000547:Amantadine / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002986:Clinical Trials as Topic; D060085:Coinfection; D024882:Drug Resistance, Viral / Q000235:genetics; D004770:Enterovirus / Q000145:classification / Q000187:drug effects* / Q000235:genetics* / Q000472:pathogenicity; D004769:Enterovirus Infections / Q000188:drug therapy* / Q000276:immunology / Q000635:transmission / Q000821:virology; D062665:Epidemiological Monitoring; D006526:Hepatitis C / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host; D007251:Influenza, Human / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D011634:Public Health; D012254:Ribavirin / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D000547:Amantadine