title: Neuraminidase inhibitor therapy in a military population.
abstract: BACKGROUND
  Although neuraminidase inhibitors (NI) are the mainstay of treatment for influenza infection, prescribing practice for these agents is not well described. Additionally, benefit is contested.
  
  
  OBJECTIVE
  We examined provider prescriptions of NI during the 2009 pandemic and post-pandemic periods. We also evaluated the effectiveness of NI in reducing severity of influenza infection.
  
  
  METHODS
  Data on NI prescription and severity of influenza infection were compiled in healthy pediatric and adult beneficiaries enrolled in a prospective study of influenza like illness conducted at five military medical centers over five years. Subjects underwent nasal swabs to determine viral etiology of their infection. Demographic, medication and severity data were collected. Subjects with positive influenza were included.
  
  
  RESULTS
  Two hundred sixty three subjects were influenza positive [38% [H1N1] pdm09, 38.4% H3N2, and 20.5% B); 23.9% were treated with NI. NI were initiated within 48h in 63% of treated subjects. Although NI use increased over the five years of the study, early use declined. Most measures for severity of illness were not significantly reduced with NI; adults treated within 48h had only a modest reduction in duration and severity of some of their symptoms.
  
  
  CONCLUSIONS
  NI use in our population is increasing, but early use is not. NI use resulted in no reduction in complications of illness. Resolution of symptoms and reduction in severity of some symptoms were slightly better in adults who were treated early. These modest benefits do not support routine treatment with NI in otherwise healthy individuals with influenza.
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States; Madigan Army Medical Center, Tacoma, WA, United States. Electronic address: mary.p.fairchok.ctr@mail.mil.
authors.forename: Mary P
authors.initials: MP
authors.lastname: Fairchok
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States.
authors.forename: Wei-Ju
authors.initials: WJ
authors.lastname: Chen
authors.affiliation: Naval Medical Center, San Diego, CA, United States.
authors.forename: John C
authors.initials: JC
authors.lastname: Arnold
authors.affiliation: Madigan Army Medical Center, Tacoma, WA, United States.
authors.forename: Christina
authors.initials: C
authors.lastname: Schofield
authors.affiliation: San Antonio Military Medical Center, San Antonio, TX, United States.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Danaher
authors.affiliation: Naval Health Research Center, San Diego, CA, United States.
authors.forename: Erin A
authors.initials: EA
authors.lastname: McDonough
authors.affiliation: Office of Curriculum, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
authors.forename: Martin
authors.initials: M
authors.lastname: Ottolini
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States.
authors.forename: Deepika
authors.initials: D
authors.lastname: Mor
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States.
authors.forename: Michelande
authors.initials: M
authors.lastname: Ridore
authors.affiliation: Office of Curriculum, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Walter Reed National Military Medical Center, Bethesda, MD, United States.
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Burgess
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States.
authors.forename: Eugene V
authors.initials: EV
authors.lastname: Millar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D005192:Family Health; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009439:Neuraminidase / Q000037:antagonists & inhibitors*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D009439:Neuraminidase
keywords: Antivirals; Influenza; Neuraminidase inhibitors; Prescription; Severity