Amantadine has been available for decades for treatment of influenza infection and if administered early (less than 24-48 hours) after symptom onset has a modest but significant effect in reducing symptoms. There are, though, a number of considerations in its use. First, the drug has no significant effect on influenza B strains. Second, resistance among influenza A strains is common and varies from year to year. Third, there are a number of drug interactions with this agent and care must be used in the elderly and those with reduced renal function. Because of these limitations, generally speaking neuraminidase inhibitors (i.e. oseltamivir) have become preferred agents for treatment in recent years.

But in some strains where neuraminidase resistance has occurred, amantidine was active and the drug of choice. Because resistance testing isn’t often rapidly available, treatment choice usually is guided by recommendations from public health officials based on the most recent epidemiology.

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