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    Resistance to influenza neuraminidase inhibitors

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    Annual epidemics and periodic pandemics caused by influenza viruses are associated with significant disease burden. Three classes of antiviral compounds, M2 ion-channel blockers (Amantadine and Rimantadine), neuraminidase (NA) inhibitors (Zanamivir, Oseltamivir, Peramivir, Laninamivir), and RNA-dependent RNA polymerase inhibitor (Favipiravir) have been approved for clinical use against influenza infections to date. The M2 ion-channel blockers effective in inhibiting proton conductivity of influenza A viruses were no longer recommended for clinical use since 2009 due to high prevalence of resistant variants among seasonal influenza A viruses of H3N2 and H1N1 subtypes. NA inhibitors are the current mainstays for influenza prophylaxis and treatment. Four approved NA inhibitors were structural-based designed to achieve specific interactions with the conserved residues at the NA enzyme site. This Chapter will discuss the resistance mechanisms for the NA inhibitors
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