Evaluation of Oseltamivir Used to Prevent Hospitalization in Outpatients With Influenza: A Systematic Review and Meta-Analysis

Clinical Outcomes of Rapid Respiratory Virus Testing in Emergency Departments: A Systematic Review and Meta-Analysis

Importance

Rapid tests for respiratory viruses, including multiplex panels, are increasingly available in emergency departments (EDs). Their association with patient outcomes remains unclear.

Objective

To determine if ED rapid respiratory virus testing in patients with suspected acute respiratory infection (ARI) was associated with decreased antibiotic use, ancillary tests, ED length of stay, and ED return visits and hospitalization and increased influenza antiviral treatment.

Data Sources

Ovid MEDLINE, Embase (Ovid), Scopus, and Web of Science from 1985 to November 14, 2022.

Study Selection

Randomized clinical trials of patients of any age with ARI in an ED. The primary intervention was rapid viral testing.

Data Extraction and Synthesis

Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Two independent reviewers (T.S. and K.W.) extracted data and assessed risk of bias using the Cochrane Risk of Bias, version 2.0. Estimates were pooled using random-effects models. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework.

Main Outcomes and Measures

Antibiotic use and secondary outcomes were pooled separately as risk ratios (RRs) and risk difference estimates with 95% CIs.

Results

Of 7157 studies identified, 11 (0.2%; n = 6068 patients) were included in pooled analyses. Routine rapid viral testing was not associated with antibiotic use (RR, 0.99; 95% CI, 0.93-1.05; high certainty) but was associated with higher use of influenza antivirals (RR, 1.33; 95% CI, 1.02-1.75; moderate certainty) and lower use of chest radiography (RR, 0.88; 95% CI, 0.79-0.98; moderate certainty) and blood tests (RR, 0.81; 95% CI, 0.69-0.97; moderate certainty). There was no association with urine testing (RR, 0.95; 95% CI, 0.77-1.17; low certainty), ED length of stay (0 hours; 95% CI, -0.17 to 0.16; moderate certainty), return visits (RR, 0.93; 95%, CI 0.79-1.08; moderate certainty) or hospitalization (RR, 1.01; 95% CI, 0.95-1.08; high certainty). Adults represented 963 participants (16%). There was no association of viral testing with antibiotic use in any prespecified subgroup by age, test method, publication date, number of viral targets, risk of bias, or industry funding.

Conclusions and Relevance

The results of this systematic review and meta-analysis suggest that there are limited benefits of routine viral testing in EDs for patients with ARI. Further studies in adults, especially those with high-risk conditions, are warranted.

Does oseltamivir prevent hospitalisation in people with influenza?

Overview of: Hanula R, Bortolussi-Courval É, Mendel A, et al. Evaluation of oseltamivir used to prevent hospitalization in outpatients with influenza: a systematic review and meta-analysis. JAMA Internal Medicine 2024;184:18-27.

Antiviral Activity of Probenecid and Oseltamivir on Influenza Virus Replication

Influenza can cause respiratory infections, leading to significant morbidity and mortality in humans. While current influenza vaccines offer varying levels of protection, there remains a pressing need for effective antiviral drugs to supplement vaccine efforts. Currently, the FDA-approved antiviral drugs for influenza include oseltamivir, zanamivir, peramivir, and baloxavir marboxil. These antivirals primarily target the virus, making them vulnerable to drug resistance. In this study, we evaluated the efficacy of the neuraminidase inhibitor, oseltamivir, against probenecid, which targets the host cells and is less likely to engender resistance. Our results show that probenecid has superior antiviral efficacy compared to oseltamivir in both in vitro replication assays and in vivo mouse models of influenza infection.

Drug treatment for Covid-19 - three years later

There has been a profusion of trials for SARS CoV2 drugs. A review dating from May 2020 listed 115 medicines, most of which previously existed, having been investigated since the onset of the pandemic. Over an exceedingly short lapse of time, the perspective of the arrival of a new antiviral treatment specifically targeting COVID-19 appeared highly improbable. Three years later, only one treatment is recommended in France: the nirmatrelvir + ritonavir combination. While remdesivir remains available, it is only proposed when this combination is officially contraindicated. Three monoclonal antibodies, taken alone or in association, are currently available in France:: tixagevimab/cilgavimab, casirivimab/imdevimab and sotrovimab. While all three of them have received European market authorization for patients presenting with an increased risk of evolution toward a severe form of COVID-19, and while early access is possible, they are no longer recommended, the reason being a loss or alteration of activity on variants carrying a Spike protein mutation. RoActemra is a humanized monoclonal antibody that blocks the action of interleukin 6 receptors; it is exclusively reserved for adult patients receiving systemic corticotherapy and necessitating oxygen supplementation, while patients under invasive mechanical ventilation are excluded. All in all, since the onset of the pandemic dozens of products have been subjected to tests or trials; three years later, only a highly limited number of "candidates" remain, and definitive assessment has yet to be achieved.