Influenza poses a significant burden on society and health care systems. Although antivirals are an integral tool in effective influenza management, the potential for the emergence of antiviral-resistant viruses can lead to uncertainty and hesitation among front-line prescribers and policy makers. Here, we provide an overview of influenza antiviral resistance in context, exploring the key concepts underlying its development and clinical impact. Due to the acute nature of influenza in immunocompetent patients, resistant viruses that develop during antiviral treatment of a single patient (“treatment-emergent resistance”) are usually cleared in a relatively short time, with no impact on future antiviral efficacy. In addition, although available data are limited by small numbers of patients, they show that antiviral treatment still provides clinical benefit to the patient within whom resistance emerges. In contrast, the sustained community transmission of resistant variants in the absence of treatment (“acquired resistance”) is of greater concern and can potentially render front-line antivirals ineffective. Importantly, however, resistant viruses are usually associated with reduced fitness such that their widespread transmission is relatively rare. Influenza antivirals are an essential part of effective influenza management due to their ability to reduce the risk of complications and death in infected patients. Although antiviral resistance should be taken seriously and requires continuous careful monitoring, it is not comparable to antibiotic resistance in bacteria, which can become permanent and widespread, with far-reaching medical consequences. The benefits of antiviral treatment far outweigh concerns of potential resistance, which in the vast majority of cases does not have a significant clinical impact.

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了解对流感抗病毒药物耐药性的影响

流感对社会和卫生保健系统造成重大负担。尽管抗病毒药物是有效管理流感的不可或缺的工具，但抗病毒病毒出现的可能性可能会导致一线处方者和政策制定者的不确定性和犹豫不决。在这里，我们在上下文中概述了流感抗病毒药物的耐药性，探讨了其发展和临床影响背后的关键概念。由于流感在免疫功能正常的患者中具有急性性质，在单个患者的抗病毒治疗期间产生的耐药病毒（“治疗出现的耐药性”）通常在相对较短的时间内被清除，对未来的抗病毒疗效没有影响。此外，尽管可用数据受限于少数患者，他们表明，抗病毒治疗仍然为出现耐药性的患者提供临床益处。相比之下，在没有治疗的情况下耐药变异的持续社区传播（“获得性耐药”）更令人担忧，并可能导致一线抗病毒药物无效。然而，重要的是，抗性病毒通常与适应性降低有关，因此它们的广泛传播相对罕见。流感抗病毒药物是有效流感管理的重要组成部分，因为它们能够降低感染患者并发症和死亡的风险。尽管应认真对待抗病毒耐药性并需要持续仔细监测，但它无法与细菌中的抗生素耐药性相提并论，后者可能会变得永久性和广泛传播，具有深远的医学后果。抗病毒治疗的好处远远超过对潜在耐药性的担忧，在绝大多数情况下，耐药性不会产生显着的临床影响。