On the same day that a controversial review of the efficacy of Tamiflu appeared in the BMJ (see BMJ: A Review Of Tamiflu’s Efficacy Against Seasonal Influenza), the CDC updated their recommendations for the use of antivirals against influenza.
Despite the uproar raised by the Cochrane Group’s study, the truth is we’ve very little else available to treat influenza. The only current alternative for novel H1N1 is GSK’s Relenza – which is an inhaled powder.
Relenza is more difficult to administer – particularly to those with lung issues – and is in shorter supply than Tamiflu.
While the benefits of widespread Tamiflu use in healthy adults remain unproven - anecdotal evidence is pretty strong that in serious cases of influenza it can inhibit the replication of the virus enough to make a difference in patient outcomes.
Tamiflu, like any drug, can have unwanted and adverse side effects. And like any drug, a risk-reward analysis must be made for each patient to decide if the use of the drug is justified.
Here in the US, the CDC is not recommending its use in healthy adults against mild or uncomplicated influenza – although it may be `considered’.
Here is the current decision tree.
The CDC’s recommendations are lengthy, so I’ve just reproduced the Table of Contents with Jump links.
It is well worth reading completely, particularly for clinicians.
Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season
December 07, 2009 5:00 PM ET
On this Page
- Treatment of confirmed or suspected influenza
- Antiviral Chemoprophylaxis of exposed individuals
- Antiviral drug use for control of influenza outbreaks in institutions
- Specific regimens for treatment and chemoprophylaxis of influenza
- Antiviral prescription and dispensing considerations
- Adverse events and contraindications
- Further information
These recommendations contain the following updates:
- Information regarding use of intravenous peramivir under an emergency use authorization
- Information on availability of renal dosing for peramivir
- Updated oseltamivir dosing instructions for children younger than 1 year of age based on weight
- Antiviral treatment and chemoprophylaxis considerations for patients vaccinated with 2009 H1N1 and seasonal influenza vaccines
- Guidance on early empiric antiviral treatment for patients with progressive or severe influenza-like illness, regardless of underlying medical conditions
- Guidance on early empiric antiviral treatment patients with underlying medical conditions placing them at risk for complications
- Clarification of treatment considerations for patients with illness longer than 48 hours
These recommendations focus on the use of antiviral medications for the treatment and chemoprophylaxis of influenza. As of December 4, 2009, influenza A (H1N1) virus (2009 H1N1), is the strain responsible for >99% of influenza in the U.S. during the 2009-2010 influenza season. For information about other influenza viruses refer to www.cdc.gov/flu. These recommendations were last updated on December 4, 2009, and will be updated periodically as new information becomes available.