Updated 25/08/2008
Tamiflu (oseltamivir)
In 2003, NICE approved the use of oseltamivir when influenza is circulating in the community. The patient must be over 65, or under 65 in an at risk group, and can start the treatment within 48 hours of being in contact with a person with flu-like symptoms. It should not be used for prevention of flu which requires vaccination.
Relenza
(zanamivir)
In 1999, the National Institute for
Clinical Excellence reviewed this anti-flu drug made by Glaxo and found there was
insufficient evidence of benefit for the people most at risk. As it only reduces
the symptoms by 24 to 36 hours, using it for everybody suffering from flu is
clearly an unnecessary waste of NHS resources. However, it might reduce the
number of serious complications in those at risk of needing hospital admission
and reduce the death rate in the chronic sick and elderly.
This is a summary of the guidance issued
to doctors in 2000:
Guidance on the Use of Zanamivir (Relenza) in
the treatment of Influenza
Issue date: November 2000
Review date : June 2002
This section, Section 1, constitutes the Institute's guidance on the use of
zanamivir (Relenza) in the treatment of influenza.
1. Guidance
1.1 For otherwise healthy adults with influenza, the use of zanamivir is not
recommended.
1.2 Zanamivir is recommended, when influenza is circulating in the
community, for the treatment of at-risk adults, who present within 36 hours
of the onset of influenza like illness (ILI) and who are able to commence
treatment within 48 hours of the onset of these symptoms.
1.2.1 Based on the evidence from clinical trials,
at-risk adults are
individuals falling into one or more of the following categories:
age 65 years or over
chronic respiratory disease (including chronic obstructive
pulmonary disease and asthma) requiring regular medication
significant cardiovascular disease (excluding individuals with
hypertension)
immunocompromised
diabetes mellitus
1.2.2 Community based virological surveillance schemes should be used to
indicate when influenza is circulating in the community (see paragraph 5.4).
1.2.3 Effective targeting of zanamivir for the at-risk adult population with
a high incidence of true influenza is essential to maximise both the
clinical and cost effectiveness of this therapy.
1.3 The guidance does not cover the circumstances of a pandemic or a
widespread epidemic of a new strain of influenza to which there is little
or no community resistance. In such circumstances, the Department of Health
and the National Assembly for Wales might wish to consult the
Institute on the need for supplementary guidance.
The remainder of the document is structured in the following way :
2 Clinical Need and Practice
3 The Technology
4 Evidence
5 Implications for the NHS
6 Implementation
7 Clinical Audit Advice
8 Previous Guidance
9 Further Research
10 Review of Guidance
Appendix A: Appraisal Committee
Appendix B: Sources of Evidence
Appendix C: Information for
Patients.
The full document and a Summary of Evidence are available from the NICE
website at www.nice.org.uk
Before we can prescribe any Relenza
we have to be informed that flu is "circulating" in our community.
Official guidelines state that flu is considered to be "circulating" when
there are between 50 and 400 cases per 100,000 GP consultations a week. The patients
eligible must fall into one of the groups highlighted in paragraph 1.2.1 above.
The method of distribution locally has yet to be published.
Relenza does not replace flu immunisation. The
degree of protection from complications is much less with Relenza than
preventing flu by development of natural immune protection after having the
vaccine.
It is not too late to get protected. If you are in a risk group ask a
receptionist to organise a prescription for the vaccine, take it to a chemist to
collect the vaccine and then make arrangements with our nurses for them to
administer it.
The Minster Practice, Lichfield
