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Go-ahead for off-license Tamiflu and Relenza in children with swine flu

By Lilian Anekwe

Exclusive: GPs have been given the go-ahead to prescribe antivirals to children and babies with suspected swine flu, the MHRA has revealed.

Guidance from the Health Protection Agency instructs GPs to prescribe Tamiflu to close contacts within seven days of exposure to probable or confirmed cases of swine flu.

Tamiflu is not indicated in children under one year old and another flu antiviral, Relenza, is not licensed in those under five, posing a possible legal risk for GPs who prescribe antivirals to young children.

But a spokesperson for the MHRA told Pulse an agreement had been reached with the Department of Health on allowing GPs to prescribe the drugs in the specific conditions indicated in the HPA guidance.

The spokesperson said: ‘Relenza is not licensed under five years and Tamiflu not in under-ones. But the DH has a policy to allow prescribing of Tamiflu and Relenza, which should allow GPs to prescribe in these groups.'

Pulse understands emergency legislation will be forced through the House of Commons this week to change the national position on prescribing flu antivirals.

At the same time, GPs face a huge task arranging blood tests for close contacts of patients with suspected swine flu.

The HPA's guidance on screening and assessment of contacts recommends taking nose and throat swabs only, but, confusingly, separate HPA guidance on post-exposure prophylaxis says GPs should arrange for two blood specimens from close contacts of confirmed cases ‘as soon as possible'.

This leaves GPs with a severe logistical headache in arranging blood tests for contacts who may live miles from the practice.

GPs are expected to arrange two blood tests – one immediately after a case is confirmed, and another 14 days after the last exposure to the patient.

GPs must also ‘provide information leaflets and co-ordinate passive follow-up for seven days after last exposure'. The HPA would not commit to helping GPs arrange blood specimens or follow-up of patients.

If the workload in dealing with suspected cases of swine flu continues to rise, GPs may be told to suspend QOF work ‘which is not essential to clinical demand', guidance from the BMA and RCGP warns.

Dr Peter Holden, the GPC's lead negotiator on pandemic flu, who helped draft the joint BMA and RCGP document earlier this year, said high-level talks this week would decide on how that might happen, and warned many PCTs were still ill-placed to manage a pandemic.

‘Trusts need to stop micro-managing or running around like headless chickens. We will be meeting with the DH about what needs to be done and PCTs and practices will need to be ready.'

Tamiflu: current license is for it not to be prescribed to under 1s Tamiflu: current license is for it not to be prescribed to under 1s

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