Don’t give children swine flu drugs, says Oxford research

CHILDREN should not be given the antiviral drug Tamiflu to combat swine flu, researchers have warned.

The experts from Oxford University said their research, based on the drug’s effect on seasonal flu, suggests the risks to children outweigh any benefits.

But the National Public Health Service in Wales (NPHS) today said it believed a “safety-first” approach of offering Tamiflu to all children under five was sensible. All children under five and older children who have underlying chronic conditions and swine flu symptoms are offered
Tamiflu in Wales in a bid to prevent complications.

The policy of offering Tamiflu during the swine flu pandemic was called into question yesterday following the publication of the research.
It warned that Tamiflu can cause vomiting in some children, which can lead to dehydration and the need for hospital treatment. The researchers said children should not be given the drug if they have a mild form of flu, although they urged parents and GPs to remain vigilant for signs of complications.

The study, published on bmj.com, found Tamiflu and another antiviral, Relenza, had little or no effect on asthma flare-ups, ear infections or the likelihood of a child needing antibiotics.
And they said, although it was difficult to know the extent to which the findings could be translated to children affected by swine flu, based on current evidence, the effects of antivirals on reducing the course of illness or preventing complications might be limited.

Dr Carl Heneghan, a GP and clinical lecturer at Oxford University, said the current policy of giving Tamiflu for mild illness was an “inappropriate strategy”.
He added: “The downside of the harms outweigh the one-day reduction in symptomatic benefits.”
And he advised GPs “not to rely on Tamiflu as a treatment to reduce complications” or to think of it as a “magic bullet”, warning its widespread use could result in the H1N1 virus becoming resistant to the drug.

Dr Matthew Thompson, a GP and senior clinical scientist at Oxford University, said: “The current swine flu is generally a mild flu illness – it does not seem that different from current seasonal flu. We would be happy to say our results apply to the current swine flu strain.”

Wales’ approach to the use of Tamiflu has been more conservative to that in England, which has experienced higher levels of swine flu in the past three months.
Some 300,000 doses of Tamiflu have been prescribed in England, mainly through the National Pandemic Flu Service.

It is not yet known how many doses of Tamiflu have been prescribed in Wales – it is thought that the 99 people who have been confirmed with swine flu have been offered the antiviral.
Dr John Watkins, a consultant in public health medicine for the NPHS, said: “As the authors themselves note, the extent to which the findings can be applied to the current pandemic is questionable and no children with H1N1 have been tested as part of this research.

“We already know that swine flu behaves differently to seasonal flu, and past pandemics have hit younger people hardest.
“While there is concern about how swine flu affects children, we believe a safety-first approach of offering antivirals to symptomatic children in Wales remains a sensible and responsible way forward.

“The BMJ research is correct to say that many people with swine flu only have mild symptoms, and we advise that people who do not fall into at-risk groups and are experiencing mild symptoms should treat themselves at home with bed rest and over-the-counter flu remedies.

“But for those in at-risk groups and those who experience severe symptoms, the best scientific advice tells us that antivirals should still be taken as soon as possible and that the course should be completed even if the patient feels better.”

Dr Jane Wilkinson, Wales’ deputy chief medical officer, said: “We welcome research into influenza as the findings may help us tackle this pandemic influenza outbreak.
“It is important to point out, however, that the BMJ review is based on seasonal flu and not swine flu.

“For most people this illness is mild and they will get better within five to seven days.

“However, for those who experience severe symptoms and those who are in at-risk groups – such as those with chronic conditions, pregnant women or children under five – antivirals are provided to help reduce the symptoms of the virus.

“The advice still remains to get antivirals to these groups within 48 hours to maximise their effectiveness.
“If parents have any concerns about whether their children should take Tamiflu, they should discuss this with their GP.”