A scoping review of existing guidelines and recommendations for the use of influenza antiviral medications

Background: Antiviral medications (AV) are available to mitigate mortality, morbidity, and absenteeism associated with influenza. Management of the burden of influenza is a concern to governing organizations, and thus it is important to understand how AVs are used in practice. To address this, the study reviewed recommendations and guidelines for AV use in situations of seasonal, pandemic, and novel/variant influenza from organizations around the world. Methods: Electronic databases, government and international websites, and Google were searched for guidelines and recommendations developed at the national and international levels by governments, intergovernmental organizations, and task forces that identify AV use recommendations. Results: Of 609 documents retrieved from the electronic search and manual review, 57 were included. Neuraminidase inhibitors (NIs) were recommended for use in nearly 80% of guidelines. Oseltamivir or oseltamivir/zanamivir were recommended for use in 38.6% and 40.4% of guidelines, respectively. Most guidelines based their recommendations on explicit evidence, the majority of which cited WHO documents. AV use was recommended for the general population in 42 guidelines; oseltamivir was recommended most commonly for both prophylaxis and treatment. Conclusions: The majority of guidelines covering subpopulations recommended the use of AVs. Details of AV administration (dose, duration, and timing), when reported, were consistent by indication. Guidelines recommending use of adamantanes were either published before 2007 or recommended their use for specific subpopulations. Guidelines were generally consistent in recommending the use of NIs for indication, type of influenza, setting, subpopulation, and evidence used to inform the recommendation.