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To the Editor: Dr Wenzel's Editorial¹ regarding anti-influenza drugs could be interpreted as dismissing the "first-generation" agents amantadine and rimantadine in favor of the newer "second-generation" neuraminidase inhibitors oseltamivir and zanamivir. Following a brief mention of the approved indications for the older agents, he provides a detailed list of the limitations of amantadine and rimantadine. The implication seems to be that the older agents are flawed and obsolete.

However, most of the deficiencies cited for the older agents are either of limited clinical relevance (eg, influenza B, renal dysfunction, and seizure disorders are uncommon and dose adjustment in renal dysfunction is simple), or apply equally to the newer agents (eg, significant adverse drug effects and drug resistance occur in an appreciable minority of patients). The cost-effectiveness dilemma presented by the newer agents is largely a function of their higher cost. Perhaps the newer, more expensive drugs should be reserved for . . . [Full Text of this Article]

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Expanding the Treatment Options for Influenza
Richard P. Wenzel
JAMA. 2000;283(8):1057-1059.
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