Tuesday, July 28, 2009

Tom Nolan: Prescribing antivirals - is beyond 48 hours too late?

22 Jul, 09 | by julietwalker

After Monday’s statement to the House of Commons from Andy Burnham (you can watch all ten hours of the commons session here), the RCGP emailed members to summarise this and other developments.

One question raised by the e-mail is over the recommendation for GPs to prescribe antivirals if the patient has been symptomatic for fewer than seven days. That’s five days longer than was recommended in the old NICE guidelines for seasonal influenza. So why the change? Here’s the response from the Department of Health.

“The decision…was based on accumulating evidence that tamiflu can provide benefit for severe or prolonged cases, whose course of disease is likely to be longer than the 3-4 days in the healthy community cases which were the basis of the licensing process.

“Applications for licensing have to include large ‘pivotal’ studies to demonstrate the efficacy and safety of a medicine. In the community, where most cases last around 4.6-5 days, the medicine had to be given very early, in order to demonstrate any significant shortening of the illness.

“Older patients, those already severely ill and those predisposed to severe illness, however, appear to benefit from treatment started later than this. The Department of Health SAGE (Scientific Advisory Committee for Emergencies) examined current evidence and supported a lengthening of the time-window for treatment.”

Based on the answer given in the last of these paragraphs, couldn’t you argue that the window only be extended beyond 48 hours to those who are “older”, “already severely ill” and “predisposed to illness”? The stockpile of antivirals may be large, but unnecessary prescribing only increases the likelihood of resistance and puts greater strain on services.

Tom Nolan is the clinical community editor of doc2doc, the BMJ’s professional networking community.

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