CDC officials urge restricted use of Tamiflu, Relenza.
9/10/09 There are now reports today of the first known cases of human to human spread of H1N1 resistant to Tamiflu. It highlights the importance of the newest CDC guidelines re the need to severely restrict the use of Tamiflu to treat or prophylax patients for H1N1 this fall and winter
On 9/9, the CDC basically said that the only patients to treat would be those with pre-existing conditions that would put them at risk (e.g. diabetes, asthma, pregnancy) or patients who are hospitalized. The following is an excerpt of the statement (bold type added):
CDC officials urge restricted use of Tamiflu, Relenza.
The AP (9/9, Stobbe) reports that the federal government on Tuesday issued new guidelines regarding Tamiflu and Relenza, recommending that the drugs "should only be used to treat people who are sick and at high risk for complications." At a news conference on Tuesday, Dr. Anne Schuchat of the CDC, said, "The majority of adolescents and adults and most children won't need antivirals." The advice "tries to close a door that government doctors had left open with earlier guidance in May," when they did not rule out the treatment as a possibility for children who were not exhibiting symptoms. Health officials "want to avoid overuse of Tamiflu and Relenza, because a virus can develop a resistance, making the drugs ineffective." To date, the agency "said it's aware of only nine cases of Tamiflu-resistance in swine flu, and several were people who were taking the drug as a preventive rather than as a treatment."
The Washington Post (9/9, Brown) reports that authorities said practitioners "shouldn't wait for lab tests to confirm the presence of the novel strain of the H1N1 virus before starting antivirals in high-risk patients who show symptoms of flu," as the drugs have proven most effective "when started within 48 hours of illness." Dr. Schuchat called that time window "very important." Additionally, the CDC now says it is also acceptable for practitioners to monitor high risk patients carefully and prescribe an antiviral "only if a fever develops." CQ HealthBeat (9/9, Adofo) reports that Schuchat "rejected suggestions that antiviral medication may be inaccessible in certain areas or under-supplied."
In terms of common sense guidelines, patients at high risk would include those on chemotherapy or those who are pregnant. Physicians need to make decisions on a case by case basis to decide whom should be treated. However, for the vast majority of the U.S. population at risk (which basically includes anyone born after 1957), the CDC recommendations are clear. People who are ill should stay home from work or school and treat themselves as they would re any respiratory infection. If their symptoms persist beyond a reasonable period or worsen to the point of fears re secondary infections or dehydration, they should seek medical care.
In terms of pediatric patients, there is great confusion. Initially, there were thoughts of treating all children below 5 (in reality, from 12 months and up per the Tamiflu labeling) but the newest data suggests that the greatest risk may be in those less than 24 months. Parents should seek guidance from their physicians in regard to this young cohort in the pediatric population.
Obviously, things are not as clear as physicians or patients would like. However, in an evolving situation like the current pandemic, what is the rule today becomes out of date fairly quickly.
Mark M. Blatter, M.D.
Medical Director
Primary Physicians Research