Influenza A Treatment: Our Shrinking Armamentarium

Influenza A Treatment: Our Shrinking Armamentarium

The CDC recommends against the use of adamantanes for treating influenza A for the remainder of the 2005–2006 flu season.

Adamantanes (amantadine and rimantadine) have been the mainstay of treatment and prophylaxis for influenza A viruses; until recently, resistance to these drugs was infrequent. However, increasing resistance in the U.S. during the past 2 years prompted CDC investigators to test for viral mutations leading to resistance among all isolates submitted from October 1 to December 31, 2005.

A total of 209 H3N2 influenza A isolates from patients in 26 states were tested using a pyrosequencing method for rapid analysis of antiviral mutations. Ninety-two percent carried a mutation in the M2 gene, which is known to confer resistance to the adamantine class of drugs. Of eight H1N1 influenza A isolates tested, 25% contained the mutation. Three isolates from Canada and 10 from Mexico showed the same mutation. Bioassays testing for resistance showed complete concordance with pyrosequencing for the mutation.

Comment: In a health alert issued January 14, 2006 (http://www.cdc.gov/flu/han011406.htm), the CDC recommends that adamantanes not be used for the remainder of the 2005–2006 influenza season. This class of drugs should not be prescribed for influenza in future seasons unless and until there is a documented change in the resistance pattern. This development also reminds us why we should not issue prescriptions for or stockpile these drugs despite increasing patient requests. Resistance develops against every class of antimicrobials when they are not used judiciously. The limitations of treatment also remind us that prevention (vaccination) is always preferable to treatment.

— Peggy Sue Weintrub, MD

Published in Journal Watch Pediatrics and Adolescent Medicine February 10, 2006

Citation(s):

Bright RA et al. Adamantane resistance among influenza A viruses isolated early during the 2005-2006 influenza season in the United States. JAMA 2006 Feb 2; 295: e1-4 (http://jama.ama-assn.org/cgi/content/full/295.8.joc60020v1).

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