A literature review published in the journal Infection and Drug Resistance discusses the role of peramivir injection in the treatment of acute influenza.

Influenza infection stands as a major cause of morbidity and mortality in adults and children across the world. Rapid viral evolution has resulted in seasonal influenza epidemics whereas frequent antigenic variants have contributed to pandemics and sporadic/endemic avian influenza virus infections. 

While annual influenza vaccination remains standard for influenza prevention, effective antiviral agents are still needed for prophylaxis and treatment against influenza. In the U.S., approved antiviral agents include neuraminidase inhibitors (ie, oseltamivir, zanamivir), and adamantanes (ie, amantadine, rimantadine). 

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Peramivir, a neuraminidase inhibitor, was recently approved by the Food and Drug Administration (FDA) for the treatment of acute uncomplicated influenza in adults. Its chemical makeup enables binding to the influenza neuraminidase with much greater affinity than oseltamivir. Peramivir is effective against a variety of influenza A and B subtypes and possesses a lower half-maximal inhibitory concentration compared to other NAIs in in vitro studies. Its long half-life allows for once-daily dosing and because it can be administered intravenously, peramivir may be a favorable option for critically ill patients hospitalized with influenza

The FDA approval of peramivir was based on data from 27 clinical trials evaluating over 2,700 patients. In one Phase 3, randomized, double-blind study, which included ambulatory patients with acute uncomplicated influenza, those who received a single dose of peramivir (300mg or 600mg) had similar time to alleviation of flu symptoms as those who received oseltamivir 75mg twice daily for 5 days; the authors of this study concluded that both doses of peramivir were noninferior to oseltamivir. With regards to hospitalized patients, the National Institutes of Health conducted a Phase 3, randomized, open-label study where patients (14–92 years old) with confirmed or suspected H1N1 influenza received either peramivir 300mg twice daily or 600mg once daily. Over the first 24 hours there was a similar reduction in influenza virus titers with both regimens. Another study conducted in hospitalized patients compared the two dosing regimens of peramivir (300mg twice daily vs. 600mg once daily) and found that peramivir was safe and well-tolerated in both groups.

Annual immunization and optimal antiviral usage are important factors in controlling influenza virus outbreaks. Since peramivir is a parenteral agent it may be more appropriate for use in a clinic or inpatient setting where adherence is monitored by a healthcare team. For patients with renal dysfunction, peramivir does require dose adjustments as it is primarily cleared by the kidneys. Since it is not hepatically metabolized, the likelihood of drug interactions with peramivir is low. While some case reports and studies support the use of peramivir in pregnant women and children, more research is needed in these patient populations. Studies showing that peramivir reduces the likelihood of hospitalization or death are also lacking.

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