Tamiflu – is it worth it?

Many of you may have come across the correspondance between BMJ and Roche already regarding Tamiflu. If not, take a moment to look it over, don’t worry, I’ll wait.

http://www.bmj.com/tamiflu/roche

OK, welcome back…

Here’s the bottom line – the flu vaccine is still available in the community and is the best defense. The principal circulating viruses are AH3N2 and are associated with more severe disease per the CDC. H1N1 – remember that one – have been circulating over the past several years.

Last month the FDA approved oseltamivir (Tamiflu) for the treatment of influenza in infants as young as 2 weeks of age (3mg/kg per dose twice daily). Rapid diagnostic testing should not be used to “rule-out” influenza as the sensitivity is <50%. Specificity is in excess of 90% for many rapid flu antigen of these assays. The bottom-line is that a positive result is reliable – a negative not so much

Antiviral treatment is recommended for patients with confirmed or suspected influenza who have severe, complicated, or progressive illness or who require hospitalization, or who have an illness that puts them at higher risk for complications based on their age or medical conditions. Treatment is ideally initiated at <48 hours of illness – but 3-4 days in may still be beneficial for high risk patients.

All of this sounds great – but do I really need to write for it? What about the mom that is demanding Tamiflu. Remember that the neuropsychiatric side effects can be significant. We’re talking hallucinations agitation and psychosis. Is that potential worth one less day of missed school or work. That’s up for you to decide. We are also hearing of reports of shortages in some areas. I rarely prescribe it in our ED – but I do feel prepared to discuss it with families. The decision is yours – I just urge you to be a well informed provider