Clearing the Air Around Influenza
Treatment
Prevention of transmission and treatment of infection and its complications with respiratory viruses focuses on specific interventions (antivirals) and aspecific interventions (e.g. antipyretics, vitamins, anti-inflammatory compounds).
Given the aspecific nature of the ILI syndrome and the ups and downs of circulation, the most sensible interventions are drugs such as antipyretics and anti-inflammatories. These usually provide temporary relief, especially with rest and fluid replacement.
Serious complications such as pneumonia should be treated with antibiotics and more complex therapies, usually in hospital.
TTE has covered antivirals in 37 posts, totalling over 32 thousand words between March 2023 and February 2024.
We even referred to the history of their discovery with original material from the MRC Common Cold Unit. Like vaccines, scores of potential candidates did not make it to registration. Here is a description of those that did, which are all anti-influenza:
This is the bottom line based on regulatory data and 20 years of work on the newer neuraminidase inhibitors:
So, after 35 episodes, it is time to sum up what we foundÂ
Oseltamivir/Tamiflu reduces the duration of influenza-like symptoms by 16 hours
It does not affect rates of hospitalisation
It does not affect any bacterial infection in children, adults or the elderly
It does not affect viral transmission
Its mechanism of action is probably directly on the central nervous system
Three of every 100 people treated with oseltamivir/Tamiflu would self-report they don’t have pneumonia. However, there was no effect in the five trials that used an objective diagnosis of pneumonia.
If a million people took Tamiflu, 45,000 would experience vomiting, 31,000 would experience headaches, 10,000 would have renal complications, and 11,000 would suffer psychiatric harm.
Zanamivir/Relenza has a similar profile but a lower level of toxicity, possibly because of its lower bioavailability.Â
So next time you are offered either of these drugs, bear these facts in mind.
Â
This is the eighth and last of the old geezers’ simplified recap of what is known about ILIs.
ReadingsÂ
I would hope that, in the wake of 'that' event five years ago (and the following vaccine roll-out), people have become much more aware of possible side effects cause by such wonder-antivirals.
I confess I was totally unaware of those side effects you mention in regard to Tamiflu. They were certainly not mentioned in the press which was jubilant about its wonderful properties ... and then it seems to have vanished from public discourse.
I wonder if the terrible side effects of another of those wonder drugs played a role in this silence. This drug was Pandremix - and I, for one, cannot recall ever having heard of this until the reports, years later, about the poor people who in consequence became ill with narcolepsy.
So "Oseltamivir/Tamiflu" isn't a specific treatment for influenza at all but a way of relieving symptoms of ILI.
Why then does the BNF say it "Reduces replication of influenza A and B viruses by inhibiting viral neuraminidase"
Very confusing ...
https://bnf.nice.org.uk/drugs/oseltamivir/