Amantadine and rimantadine for influenza A in children and the elderly.

BACKGROUND: The effectiveness and safety of amantadine (AMT) and rimantadine (RMT) for preventing and treating influenza A in adults has been systematically reviewed. However, little is known about these treatments in children and the elderly. OBJECTIVES: To systematically review the effectiveness and safety of AMT and RMT in preventing and treating influenza A in children and the elderly. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2) which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register, MEDLINE (1966 to June week 3, 2011) and EMBASE (1980 to June 2011). SELECTION CRITERIA: Randomised controlled trials (RCTs) or quasi-RCTs comparing AMT and/or RMT with placebo, control, other antivirals or different doses or schedules of AMT or RMT, or both, or no intervention, in children and the elderly. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion and assessed methodological quality. We resolved disagreements by consensus. In all comparisons except for one, we separately analysed the trials in children and the elderly using Review Manager software. MAIN RESULTS: A total of 12 studies involving 2494 participants (1586 children and adolescents and 908 elderly) compared AMT and RMT with placebo, paracetamol (one trial; 69 children) or zanamivir (two trials; 545 seniors). All studies were RCTs but most were still susceptible to bias. Two trials in the elderly had a high risk of bias because of incomplete outcome data. In one of those trials there was also a lack of outcome assessment blinding. Risk of bias was unclear in 10 studies due to unclear random sequence generation and allocation concealment. Only two trials in children were considered to have a low risk of bias.AMT was effective in preventing influenza A in children. A total of 773 participants were included in this outcome (risk ratio (RR) 0.11; 95% confidence interval (CI) 0.04 to 0.30). The assumed risk of influenza in the control group was 10 per 100 and the corresponding risk in the RMT group was one per 100 (95% CI 0 to 3). The quality of the evidence was considered low. For treatment purposes, RMT was beneficial for abating fever on day three of treatment. For this purpose one study was selected with low risk of bias and included 69 children (RR 0.36; 95% CI 0.14 to 0.91). The assumed risk was 38 per 100 and the corresponding risk in the RMT group was 14 per 100, 95% CI 5 to 34. The quality of the evidence was moderate.RMT did not show a prophylactic effect against influenza in the elderly, but the quality of evidence was considered very low. There were 103 participants (RR 0.45; 95% CI 0.14 to 1.41, for an assumed risk of 17 per 100 and a corresponding risk in the RMT group of 7 per 100, 95% CI 2 to 23). We did not identify any AMT trials in the elderly that met our inclusion criteria.There was no evidence of adverse effects of AMT and RMT in children or an adverse effect of RMT in the elderly. We did not identify any AMT trials in the elderly that met our inclusion criteria. AUTHORS' CONCLUSIONS: AMT is effective in preventing influenza A in children but the NNTB is high (NNTB: 12 (95% CI 9 to 17). RMT probably helps the abatement of fever on day three of treatment, but the quality of the evidence is poor. Due to the small number of available studies, we could not reach a definitive conclusion on the safety of AMT or the effectiveness of RMT in preventing influenza in children and the elderly.

[Scholar absenteeism and use of health services in children and adolescents with wheezing]. / Ausentismo escolar y uso del servicio de salud en niños y adolescentes con sibilancias.

INTRODUCTION: Asthma is an important problem at the primary care level where almost 97% of the cases are managed. Brazil shows high rates of the disease nevertheless few is known about the characteristics related to school absenteeism and the health care usage among urban pediatric population of Duque de Caxias County, Rio de Janeiro. OBJECTIVES: To obtain an estimate of the prevalence of school absenteeism and to evaluate the use of health care related to wheezing in asthmatic and non asthmatic children and adolescents. MATERIAL AND METHODS: An observational cross-sectional study was carried out using a questionnaire for a prospective data collection. The gold standard for asthma was a minimal increment of 12% in the forced expiratory volume of the first second (FEV1), after a bronchodilatation test. RESULTS: 211 patients seeking emergency care for a number of conditions with ages between 5 and 15 years were evaluated. Sample asthma prevalence and reported wheezing rates were: 22% (47/211) and 47% (98/211). About 67% (141/211) of the families had an annual income lesser than US dollar 3600. Asthmatic and non-asthmatic patients showed, respectively, the following averages and rates: 1) emergency department visits: 40.4% (19/47) and 29.3% (48/164), 2) ambulatory visits: 34% (16/47) and 14.6% (24/164) (p = 0.003), 3) hospitalizations: 6.4% (3/47) and 4.9% (8/164), 4) number of consultations in ambulatory: 1.74 (SD = 2.71) and 0.47 (SD = 1.44) (p = 0.00003), 5) number of visits in emergency department: 1.47 (SD = 2.36) and 0.95 (SD = 2.15). CONCLUSION: The results are relevant as they describe asthma morbidity, showing that wheezing is a heavy burden to the population of Duque de Caxias. Further studies are needed to better evaluate the group of children and adolescents that although being classified as non-asthmatic presented some characteristics that were to the asthmatic patients.