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GPs 'bullied' into bulk prescribing flu medicine to whole care homes without necessary testing


Dig this out again: Cochrane Review of Neurominidase Inhibitors - Summary What did the study look at? Randomised, placebo-controlled trials on adults and children with confirmed or suspected exposure to naturally occurring influenza Covered 107 clinical study reports from the European Medicines Agency, GlaxoSmithKline and Roche, plus comments by US Food and Drug Administration and Japanese drugs regulator. Total of 20 trials of oseltamivir (9,623 participants) and 26 trials of zanamivir (14,628 participants) included in formal analysis after initial judgement of design of the studies. What were the main findings? Duration of symptoms and hospitalisations/complications Oseltamivir reduced the time to first alleviation of symptoms from 7.0 to 6.8 days in adults, and by 29 hours in healthy children, but had no effect in children with asthma. Zanamivir reduced the time to first alleviation of symptoms from 6.6 to 6.0 days in adults, but had no effect in children. Oseltamivir had no significant effect on hospitalisations compared with placebo, with a risk difference of 0.15%. There were no zanamivir hospitalisation data. Neither drug had any impact on serious complications of influenza leading to study withdrawal, where tested. Oseltamivir cut self-reported, investigator-mediated, unverified pneumonia by 1.0% but had no effect in five trials that used a more detailed diagnostic form of pneumonia, while zanamivir had no effect on either self-reported or radiologically confirmed pneumonia. Zanamivir reduced bronchitis risk by 1.80% in adults, but oseltamivir had no effect on this. Neither drug reduced the risk of otitis media or sinusitis in children or adults. Side effects Oseltamivir increased nausea (by 3.7%; number needed to harm [NNTH] of 28) and vomiting (4.7%; NNTH of 22) in adults and vomiting (5.3%; NNTH of 19) in children, but cut risk of diarrhoea (2.3%) and cardiac events (0.68%) in adults. Oseltamivir also had dose-response effect on psychiatric events in two ‘pivotal’ trials. Flu prevention The risk of developing symptomatic influenza was reduced by 3% by oseltamivir (number needed to benefit [NNTB] of 33) and 2% by zanamivir (NNTB of 51) in individuals but there was no reduction in asymptomatic influenza with either drug. Side effects Oseltamivir increased psychiatric events (1.1%, NNTH of 94), headaches (3.2%, NNTH of 32), renal events (0.7%, NNTH of 150) and nausea (4.2%, NNTH of 25). The Cochrane Collaboration 2014; available online 10 April

Posted date

09 Jan 2015

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