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DH 'wrong to recommend antivirals for swine flu', expert reviews warn

By Lilian Anekwe

Two reviews by leading British experts have called into question the Department of Health's policy of widespread antiviral use to tackle the swine flu pandemic.

The studies concluded that the benefit of using antivirals is likely to be ‘limited', and found that prescribing Tamiflu reduces the symptoms of seasonal flu by less than a day.

A systematic review of four trials of the treatment of seasonal flu in nearly 1,800 children treated with Tamiflu found they reduced recovery time by a median of between 0.4 and 1.5 days, duration of cough by 1.3 days and fever by 1 day.

Children given a 10-day course of antivirals given for post-exposure prophylaxis had a 7% lower risk of developing flu, with 13 children needing treatment in order to prevent one additional case of flu.

But Tamiflu treatment had no significant impact on the number of asthma exacerbations in or the incidence of otitis media, only a non-significant reduction in the use of antibiotics.

An additional one child in twenty given Tamiflu would have vomiting, researchers found.

The researchers, from the Department of Primary Care and Public Health at the University of Oxford, said the study had implications for the upcoming swine and seasonal flu seasons.

Dr Matthew Thompson, senior clinical scientist and lead author concluded in the BMJ: ‘While morbidity and mortality in the current pandemic remain low, a more conservative strategy might be considered prudent, given the limited data, side effects such as vomiting, and the potential for developing resistant strains of influenza.'

A second review by a team including researchers from the RCGP's flu surveillance unit and a member of the Joint Committee for Vaccination and Immunisation's flu sub-group concluded Tamiflu use is adults ‘is unlikely to be the most appropriate course of action'.

The review and meta-analysis of 26 trials, published in the Lancet Infectious Diseases, found Tamiflu treatment reduced the median recovery time in at-risk adults by 0.74 days, but noted that ‘there was no clear evidence of a reduction in the time to symptom alleviation'.

Professor Lesley Stewart, director of the University of York's centre for reviews and dissemination, said: ‘Recommending the use of antiviral drugs for the treatment of people presenting with symptoms is unlikely to be the most appropriate course of action, given the debatable clinical importance of their affect on symptom duration.'

A DH spokesperson said: 'The extent to which the findings can be applied to the current pandemic is questionable - after all, we already know that swine flu behaves differently to seasonal flu, and past pandemics have hit younger people hardest.

'We believe a safety-first approach of offering antivirals to everyone remains a sensible and responsible way forward. However, we will keep this policy under review as we learn more about the virus and its effects.'

A spokesperson for Roche, the manufacturer of Tamiflu, told Pulse there is 'significant data' showing the drug is safe and well-tolerated in children.

Experts have questioned the DH policy for Tamiflu use

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