In developing these recommendations, the Panel highlighted the following topics where further research is needed:

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Studies to assess the efficacy of existing and investigational antiviral and adjunctive treatments, including regional products, for severe or complicated influenza illness.

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Studies to assess efficacy of immunotherapy using either post-infection sera/plasma or monoclonal antibodies in complicated illness due to influenza virus infection.

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Comparative clinical studies of neuraminidase inhibitors, used for treatment of influenza in all populations but especially for parenteral neuraminidase inhibitors for critically ill patients, assessing comparative efficacy and safety.

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Standardization of clinical and laboratory virological endpoints used to assess outcomes for these studies.

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Comparative studies of combination treatments in all populations, but especially for severely or critically ill patients with influenza virus infection.

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Studies in children under one year to define dose, safety, and efficacy of all antivirals, particularly in neonates with influenza virus infection.

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Development of alternative formulations, including different routes of administration, of zanamivir and oseltamivir, particularly for use in severely ill patients and for infants with influenza virus infection.

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Studies of higher doses, loading doses, longer durations, and combinations.

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Definition of prognostic factors for developing severe influenza disease.

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Better pharmacokinetic and pharmacodynamic studies, with particular regard to correlations between dose, routes of administration and viral load in the (lower) respiratory tract with influenza virus infection.

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Data on treatment of influenza in particular higher risk groups, including pregnant women, obese patients, and immunosuppressed (including HIV) infected persons.

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Development of better definitions of patients with higher risk for severe or progressive influenza illness such as HIV-infected population (adults and children), obesity, pregnancy.

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Prospective studies on mechanisms and clinical conditions by which resistance to antiviral medications is likely to develop while influenza patients are under treatment.

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Development of a robust surveillance system for influenza antiviral resistance monitoring.