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August 25, 2009
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Volume 4
Issue 34
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DynaMed Systematic Literature Surveillance
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For the week ending August 21, 2009
This week, 677 articles were evaluated via DynaMed’s Systematic Literature Surveillance and 293 were added to DynaMed content.
Based on the editors’ criteria of selecting “articles most likely to change clinical practice,” three articles of significant interest were selected for the DynaMed Weekly Update.
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Neuraminidase Inhibitors May be Effective for Influenza Prevention
Last week’s DynaMed Weekly Update presented evidence on the efficacy of neuraminidase inhibitors, zanamivir (Relenza) and oseltamivir (Tamiflu), for treatment of seasonal influenza. These drugs may also be effective for prevention of seasonal influenza in children and adults (level 2 [mid-level] evidence). A systematic review of 3 randomized trials evaluated neuraminidase inhibitors for postexposure prophylaxis in 863 children ≤ 12 years old. Symptomatic influenza was confirmed in 4% of children treated with zanamivir or oseltamivir for 10 days compared to 12.8% of children receiving placebo (p < 0.001, NNT 13). No significant differences in adverse events were reported in 2 trials of zanamivir (BMJ 2009 Aug 10;339:b3172).
Another systematic review compared extended neuraminidase inhibitor treatment (4-6 weeks) to placebo in 7,201 patients (mean age 29 years). Oseltamivir was associated with an absolute risk reduction of 4.2% (95% CI 2.5%-5.8%, NNT 24) in an analysis of 3 trials and zanamivir with a reduction of 3% (95% CI 2.5%-5.5%, NNT 34) in an analysis of 2 trials compared to placebo groups with symptomatic flu rates ranging from 1.4%-13.7% (level 2 [mid-level] evidence). There were no significant differences in serious adverse events, but oseltamivir was associated with increased nausea and vomiting (Ann Intern Med 2009 Oct 6;151(7):464).
There is also evidence that hand hygiene education within 36 hours of symptom onset may reduce the rate of symptomatic flu in patients’ household contacts (level 2 [mid-level] evidence). Patients testing positive for influenza A or B and all household members were randomized to lifestyle education, specific hand hygiene education, or hand hygiene education plus advice on use of surgical masks. Incidence of symptomatic flu in household members was 23% for lifestyle education, 10.8% for hand hygiene (NNT 9 compared to lifestyle education), and 18.1% for hand hygiene plus masks (Ann Intern Med 2009 Oct 6;151(7):464).
For more information, see the Influenza antiviral treatment and prophylaxis and Influenza in adults topics in DynaMed.
For the latest evidence-based influenza-related information available for free, visit www.ebscohost.com/flu.
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DynaMed Weekly Update is a compilation of 1 to 5 articles that are of significant interest to clinicians. Articles are selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice. Updates are prepared by the DynaMed Editorial Team which includes 28 clinicians from multiple disciplines. Send comments to DynaMedEditor@epnet.com. To learn more about DynaMed, go to www.dynamicmedical.com.
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Copyright © 2009 EBSCO Publishing. All rights reserved.
DynaMed® is a registered trademark of and published by DynaMed LLC. Original date of on-line publication December 15, 1995 with continuous daily updating. ISSN: 1554-1177. Subscriptions and queries can be addressed to DynaMed LLC, EBSCO Publishing, 10 Estes St., Ipswich, Massachusetts, USA 01938-0602, telephone (978) 356-6500, facsimile (978) 356-6565, e-mail Editor@DynamicMedical.com.
The opinions expressed herein are solely those of the authors and editors and may or may not represent the official position of cooperating or endorsing Medical Societies.
Development of DynaMed was supported in part by the National Science Foundation through a Small Business Innovative Research grant. (All other support comes from subscriptions. No advertisements are accepted.) 
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