HFHT's Practising Wisely Newsletter
For the whole healthcare team.
Issue 39: Time to Put Tamiflu to Bed?
October 17, 2017
Image courtesy of Medline Plus

If flu activity in Australia and the Southern Hemisphere is any indication, Canada, and North America on the whole, could be in for a nasty flu season in the months ahead. According to Health Canada, annual influenza vaccination is the most effective way to help prevent influenza and its complications, but what role do antiviral medications play?

The World Health Organization (WHO) recently lowered the status of the antiviral oseltamivir (Tamiflu), moving it from its “core” list to its “complementary” list. WHO states that oseltamivir should be restricted to severe illness due to confirmed or suspected influenza virus infection in critically hospitalized patients.

According to an editorial in  the British Medical Journal (BMJ), the common practice of using oseltamivir to treat uncomplicated influenza is the result of a “multisystem failure,” which is an apt description for the series of decisions based on flawed evidence made by the European Medicines Agency, the Centres for Disease Control and Prevention, and WHO. These include the failure to publish all available evidence, to make the data available at the individual patient level, and to recognise the limitations of observational data. Among the factors in play in these failures were the desire for profit on behalf of Roche, the makers of Tamiflu, public fear of pandemic influenza, and politicians wanting to be seen as “doing something” to protect their constituents.

The British Medical Journal has been instrumental in trying to elucidate the Tamiflu story. Visit our Quick Links section for an excellent and comprehensive review of the story, as well as a shorter editorial version.

Despite evidence that questions the effectiveness of Tamiflu, we continue to get requests from various institutions for prescriptions for our patients who are living or working in those places. This may be due to pressure that public health and health care administrators feel to be seen as "doing something" about the flu that is an unpleasant experience for many of us each year.
Health Canada has some guidance and preventing and treating influenza, specifically with respect to antiviral medication: For people in high-risk groups or who are severely ill, health care providers may prescribe antiviral medication to reduce influenza morbidity and mortality. Find more from Health Canada by visiting our Quick Links section, and think twice before writing your next Tamiflu prescription!
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