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Four influenza antiviral drugs are currently licensed in the United States. If given within the first 48 hours, antiviral agents decrease the severity and duration of symptoms, but their ability to prevent complications of influenza A has not been established. The primary drawback of these types of medications is that resistant viruses can make them ineffective.

• One type of medication called neuraminidase inhibitors (NAIs) are FDA approved for uncomplicated influenza when the symptoms have been present for fewer than 48 hours. The main advantages of the NAIs are their activity against both influenza A and B and activity against the current circulating strains. Zanamivir (Relenza) is approved for treatment in children older than 7 years of age, but it is not approved for prevention. The drug is available as topical powder administered by a breath-activated inhalation device. Oseltamivir (Tamiflu) is licensed for children older than 1 year of age and has been recommended by the CDC for children under 1 year of age during the H1N1 outbreak. It is available as a tablet and suspension and is usually taken for five days.
• M2 inhibitors include the drugs amantadine (Symmetrel and Symadine) and rimantadine (Flumadine). Both have been used in the prevention and treatment of influenza type A. These antiviral agents are not effective against influenza B and are not approved for use in children younger than 1 year of age. Rimantadine has not been approved for treatment of children younger than 13 years of age. Amantadine and rimantadine were not recommended by the Centers for Disease Control and Prevention (CDC) for the 2009-2010 or 2011-2012 influenza season. Laboratory testing by the CDC on the predominant strain of influenza (H1N1) currently circulating in the United States shows that it is resistant to amantadine and rimantadine and therefore should not be used.
• Side effects: The use of amantadine has been associated with central nervous system side effects, including headache, insomnia, confusion, and failure to concentrate. In addition, the risk of seizure activity during therapy with amantadine in people with known seizure disorders is increased, even if they use medications to counteract that side effect. These side effects go away when a person stops taking the drug. Gastrointestinal side effects, such as nausea and loss of appetite, occur in 3% of people taking them.
• Currently, no antiviral agents exist for use against influenza C infections.
• The broad-spectrum antiviral agent ribavirin (Rebetol, Virazole Aerosol), given in aerosol form like nebulization, may be of benefit and is being studied. At the moment, its use is controversial and it is not recommended. Ribavirin is not approved for treatment of influenza in children.

Since July 2012, there have been sporadic outbreaks of variant H3N2 flu (H3N2v). This is a different type of influenza A. These cases appear to be mainly spread from pigs to humans and have been seen where close contact between humans and pigs occurred, such as at fairs. Like seasonal flu, however, serious illness, resulting in hospitalization and death is possible from H3N2v. People at high risk of serious complications from H3N2v include children younger than 5, people with certain chronic conditions like asthma, diabetes, heart disease, weakened immune systems, pregnant women, and people 65 years and older. These people were urged by the CDC to avoid pigs and pig arenas at fairs this season.

Swine flu is a respiratory disease of pigs that is also an influenza virus type A. Sometimes these viruses also infect humans and are called variant viruses.

Avian flu (bird flu) is a disease caused by influenza type A virus. This is mainly found in wild birds but can infect domestic poultry as well. Rarely it can be transmitted to humans and can cause human disease. Three types of avian influenza that are known to cause disease in birds and humans are H5, H7, and H9. Contact with infected birds is a risk factor for human infection. One concern is that an avian influenza virus may mutate to allow easier spread from person to person and thus cause an epidemic or pandemic.

Recent reports from China have focused on a new bird flu, H7N9, which is associated with contact with infected poultry. At the time of this article, there have been over 80 cases of confirmed human infection there, but none have been associated with ongoing human-to-human transmission and none have occurred outside of China.

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