Amantadine-Resistant Influenza A in Nursing Homes: Identification of a Resistant Virus Prior to Drug Use

doi:10.1001/archinte.1995.00430050113012

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Vol. 155 No. 5, 13 MARCH 1995

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Amantadine-Resistant Influenza A in Nursing Homes

Identification of a Resistant Virus Prior to Drug Use

Peter Houck, MD; Mark Hemphill, MS; Steve LaCroix, MS; Denny Hirsh, RN; Nancy Cox, PhD

Arch Intern Med. 1995;155(5):533-537.

Abstract

Background
Amantadine hydrochloride and rimantadine hydrochloride havebeen used for treatment and prevention of influenza A infectionin nursing home residents. Outbreaks of influenza A (H3N2) virusinfection occurred in three nursing homes in Yakima County,Washington, during January 1992. Amantadine was used for casetreatment and prophylaxis in all three nursing homes.

Methods
Ten influenza A (H3N2) viruses isolated during the outbreakswere examined for resistance to amantadine and rimantadine bymeans of an enzyme immunoassay and by sequencing of the viralnucleic acid that encodes the transmembrane domain of the M2protein.

Results
Five of the outbreak strains were resistant and had the samemutation (position 31, serine to asparagine) in the M2 protein.The resistant viruses included one that had been recovered priorto any use of amantadine and another that was recovered within48 hours of the first drug administration.

Conclusions
To our knowledge, this is the first report of influenza A viruswith RNA sequence—documented resistance to amantadineand rimantadine without exposure to either drug, and the shortestreported period between institution of amantadine therapy andisolation of a resistant influenza A virus strain. These resultssuggest that surveillance for amantadine- and rimantadine-resistantinfluenza A is needed, because use of these drugs will probablyincrease.

(Arch Intern Med. 1995;155:533-537)

Author Affiliations

From the Health Care Financing Administration, Region X, Seattle, Wash (Dr Houck); the Influenza Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Mr Hemphill and Dr Cox); the Virology Laboratory, Public Health Laboratories, Washington State Department of Health, Seattle (Mr LaCroix), and the Yakima (Wash) Health District (Ms Hirsh).

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