| Part I Efficacy and Safety of Neuraminidase Inhibitors in the Treatment of Influenza in Adults and Children: A Systematic ReviewObjective: To evaluate the efficacy and safety of neuraminidase inhibitors in the treatment of influenza in adults and children.Methods: Searching the literature from the PubMed, EMBase.com, Cochrane Library,CBM , CNKI, VIP, Wanfang databases according to the inclusion and exclusion criteria. Searching date since these databases was builded to December, 2016. Hand searching was also performed during the domestic and international areas of infectology magazines. Randomized controlled trials (RCTs) with neuraminidase inhibitors in the treatment of influenza in adults and children were included.Evaluating the quality of the study according to Cochrane systematic reviews handbook. Meta-analysis was performed for the homogeneous studies by The Cochrane Collaboration's software RevMan5.3 and the heterogeneous data conducted a descriptive qualitative analysis. When Meta-analysis can't be done, qualitative descriptions were made.Result: A total of 18 studies involving 8008 patients were included, there were 4540 and 3468 patients in the two groups, respectively. Effectiveness analysis showed that:comparing to the placebo group, the NAI treatment can reduce the duration of illness,the difference was statistically significant(P<0.05). Meta-analysis results showed that,compared with the placebo group treatment of neuraminidase inhibitors can reduce the incidence of otitis media who had laboratory-confirmed influenza(P<0.05), but there was no difference in the incidence of bronchitis, sinusitis and pneumonia between the two groups (P >0.05). Neuraminidase inhibitors can reduce the use of antibiotics during the flu period, but only for children who had laboratory-confirmed influenza, as for the adults, there were no significant difference between the two groups (P >0.05). In addition, there was no significantly difference in the hospitalization and relief medication between the two groups (P >0.05). To evaluate the safety, meta-analysis showed that neuraminidase inhibitors only increased the incidence of vomiting (P<0.05), but not for nausea, diarrhea, cough and headache(P >0.05), and there was no significant different in asthma exacerbation for patient who suffer from asthma (P >0.05).Conclusion: Based on existing evidence, NAI treatment can effectively reduce the duration of illness and the incidence of otitis media. Meanwhile, the usage of antibiotics in children with influenza also can be reduced, while there are no significant difference in the incidence of other complication such as bronchitis,sinusitis and pneumonia, or the incidence of hospitalization and the usage of relief medication. Treatment of neuraminidase inhibitor can increas the incidence of vomiting but not for the nausea,diarrhea, cough,headache and asthma exacerbation.Part ? The safety of neuraminidase inhibitors for treating influenza virus infection during pregnancy: a Meta analysisObjective: To assess the safety of oseltamivir in the treatment of influenza during pregnancy.Methods: Searching the literature from PubMed, The Cochrane Library, EMbase,CNKI, WanFang, VIP, CBM database. Evaluating the quality of the study according to Newcastle-Ottawa Quality Scale (NOS scale), Meta-analysis was performed for the results of homogeneous studies by The Cochrane Collaboration's software RevMan5.3.Results: Seven cohort studies were analyzed in our study,including 1917 pregnant patients who exposed to oseltamivir and 138466 unexposed patients. Compared with the unexposed group, the exposed group had lower risks of premature rupture of membranes (P < 0.05),and there was no difference of the risk for preterm delivery,preeclampsia, occurrence of fever in labor between two groups (P> 0.05). The exposed group had lower risks of fetal malformation and being small for gestational age, which was statistically different (P < 0.05), while there was no statistical difference of risks of stillborn or neonatal death and low Apgar score (P> 0.05),while.Conclusion: Based on existing evidence, our study did not find any significant association between adverse fetal outcomes, including preterm delivery, preeclampsia,occurrence of fever in labor, stillborn or neonatal death, and exposure to oseltamivir during pregnancy. In addition, oseltamivir treatment for influenza during pregnancy can reduce the risk of premature rupture of membranes, fetal malformation and being small for gestational age. |
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