I just don't understand why we are giving Tamiflu to everyone who MIGHT have swine flu but....

[seeker]

..we haven't with any other flu. Am I being stupid? Have I missed something? I understand about the high risk groups, but surely it's better for otherwise healthy children to just ride it out? Isn't the wholesale use of tamiflu for suspected cases going to speed up the arrival of a tamiflu resistant virus?

But people aren't getting secondary/more serious infections any more than with any other flu, are they?

Personally I won't be giving any of my family tamiflu "just because it is swine flu".

IF we get swine flu I will assess their/my condition and decide if they are affected seriously enough to need medical assistance.

In most cases the use of tamiflu will have no effect on the disease progression what so ever. It is only effective if started within 48hrs (24hr preferrably) of showing first symptom - and I suspect that for many people by the time theu have decided that they may have SF; got the voucher number for tamiflu and then managed to get someone to pick it up for them they are well into the 24hr if not 48hr window.

It is good as a prophylactic. It is worth taking if you have other medical concerns AND you get it v early. It may also have a benefit in reducing the infectiousnous of an individual (so the benefit is for contacts of the patient - not the patient themselves).

And as for those that are saying...well I/my relative was erally really poorly 2 days ago and now they are much better...it is more likely to be down to natural disease progression than the effects of the tamiflu.

It isn't right for everyone...but for some it is and if it stops people panicking what is the real harm as long as they put up with the side effects (resistence to tamiflu of flu strains in general is lower than you would expect - but not zero)

Thing that concerns me is that it was quoted last week that 100,000 people were "diagnosed" with swine flu in a week.

Fair enough. But they are still swabbing a small proportion of those "diagnosed" to track the disease. IIRC only 20% of those that were swabbed were actually H1N1 (or any other form of flu) positive...so actually only 20,000 people were likely to have SF....and therefore UP TO 80,000 could be taking tamiflu unnecessarily.

That is the problem I think rather than the 20,000 people that do ACTUALLY have SF taking tamiflu.

I'm a dr and I can't figure it out!

My best guess is that the government want to be seen as doing something and have a large supply of tamiflu that is about to go out of date (that they bought in for the bird flu scare).

What I do know is that I would need to be really ill to want to risk tamiflu on me or my family and I've been explaining the same to my patients.

this is an interesting read

I wouldn't touch the stuff. Neither did ds1 last week when he had SF. I realise that there may be people who are justifiably so ill that tamiflu seems like the best option but equally, everyone I know who has taken it has been as sick as a dog.

Article very interesting.

yeah good point well made, having said that you haven't had it your house. I said we wouldn't take tamiflu but we did, even I did but I missed the boat I think with the time scales and got really poorly and got a secondary chest infection, felt terrible.

My eldest had what appeared to be an accute asthma attack but she has never had asthma. This was due to a flu induced wheeze as the SF had really affected her breathing. I didn't want to give her the tamiflu but the GP said the fact she had a wheeze early on was concerning and that I should give her it, so she had it really early on few hours before she got bad, will never know if it helped or not but it certainly seemed to as recovered very quickly, amazingly so to say how poorly she was.

Would you take antivirals if you got shingles
? I can't see the difference really, although wish they would swab, diagnose and treat SF but as usual it comes down to having the man power and money to swab quickly and get results fast which they haven't got.

They dont' have enough beds to accomodate a load of people poorly from pneumonia after having flu in hospital either, think that's why they are handing out so much tamiflu. Plus they don't want the docs out examining people then all being off sick so they throw the tamiflu at you and leave you to sort it yourself!

But if it's true that it speeds recovery by 0.6 days (I've heard that from lots of other sources too) the there really is no point in taking it. The chances of taking it in the "window" are really remote and even if you do, it has very little effect. But it has unknown side effects and costs the NHS a fortune. What is going on???

As DD said earlier the government has a (apprarently) large stockpil;e going out of date which will need to be binned "soon"...so it isn't actually costing anything for the meds (distribution is another thing).

There will always be patients who are justifiably prescribed it...but it does "sound" as though it is being given out a little freely.

On the point of resistance...antoher thing to remember is that if someone that hasn't got SF takes it SF can't become resistant as the SF never meets the Tamiflu IYSWIM.

All in all - I think that it is being given a little freely, but at the end of the day it is up to teh Dr and patient to do what is best for that particular patient.

Overall, agree with PP. Some are surely getting it who don't need it, but given the numbers involved and the overwhelmed services, can see why they're handing it out...that, and the sell-by-date.

I do know of two very young children who have had uncontrollable temps who were given TAmiflu, and responded very well very fast - the parents (sensible ones who don't medicate their kids unless v worried) are convinced it made a big difference to the level of illness, rather than to how long it lasted. Its all circumstantial evidence, though, of course.

That said, if you have any asthma, or other 'underlying health issues', its good to have the option of antivirals with any flu - especially this one, which goes deeper into the lungs (so I read) than many. Both my dds and dh fall into risk categories, and I would probably risk the side effects for them all unless they were obviously not very ill in the first place - then, of course, I wouldn't.

(just realized I lumped dh in with dds, he would while I )

seeker it isn't anything to do with reducing length of illness that is just a bonus, is to do with preventing serious complications, it's up to you if you give it to yours if they have or get SF but I think I made the right choice. Would have much preferred to all be swabbed and prescribed it properly but that wasn't an option, although we were lucky in that we were examined fully and definately did have a flu and given the extremeness of my eldest's reaction in terms of breathing would think was a very good chance was SF, the docs certainly thought so.

It can be much nastier than 'normal' flu in attacking breathing of at risk groups in particular like under 5's and pregnant people, athmatics etc.

I can only say that from personal experience I believe that it has helped my family a lot. I believe that the fact that my dd and myself took tamiflu ensured that we did not get swine flu (maybe I am wrong and may be we did get it but then it was so mild that we didn't notice). I am also sure that it helped my DH he became ill on Friday evening, he had raging fever which did not come down with maximum amounts of nurofen and paracetamol (we were in trouble because he took them on the minimum intervals so he would not have been able to take much during the Saturday). Saturday morning fever was still in excess of 40 degrees. GP came at 11.00h took sample which tested positive for Influenza A, she came back at 12.00h with tamiflu for all of us. And at 13.00h fever went below 39.5 degrees for the first time since Friday night. On Sunday he still had fever (between 38 degrees and 39 degrees) but felt otherwise a lot better. On Monday fever had gone and apart from tiredness he felt fine (we all completed the full tamiflu prescription though). I believe that the two main reasons tamiflu is not normally prescribed for ordinary flu in the UK, (1) UK GPs tend to be very sceptical about tamiflu compared with for example doctors in Japan and US; and (2) several ordinary flu strains are now tamiflu resistant. Also, although local GPs are very sceptical about tamiflu (so much so that I have bought tamiflu on the internet to have it just in case, I am not on the UK mainland), our private paediatrician (based at Portland hospital) is very much in favour of early treatment with tamiflu, also whilst on holiday the local GP there was strongly in favour of us taking tamiflu, so much so, she picked it up herself and delivered it to our apartment we'd been renting! So a lot also comes down to who your doctor is I assume.

I'm deeply cynical about the whole thing - it seems more for reassurance than treatment and when you are giving drugs that can kill just to make people feel better there is something wrong.

Let's face it - if you don't swab, you don't know. How the hell do we know there isn't a new super-dooper virus doing the rounds that is quite like swine flu? Or worse that the virus is actually much more virulent because let's be clear, if lots of people are claiming to have it now and it is being assumed for planning purposes those folks will have some immunity - we could have some problems if and when wave two does hit. Suddenly twelve times as many victims are expected turn up demanding treatment and guess what, there's no Tamiflu or it doesn't work. Oopsy!

Actually it could be a whole medical tsumani for which there will be no treatment. Fine if it's low grade flu which for 99% of people causes no long term problems but if not...well we'll be a bit....ahem fucked

I'm deeply cynical about the whole thing - it seems more for reassurance than treatment and when you are giving drugs that can kill just to make people feel better there is something wrong.

Let's face it - if you don't swab, you don't know. How the hell do we know there isn't a new super-dooper virus doing the rounds that is quite like swine flu? Or worse that the virus is actually much more virulent because let's be clear, if lots of people are claiming to have it now and it is being assumed for planning purposes those folks will have some immunity - we could have some problems if and when wave two does hit. Suddenly twelve times as many victims are expected turn up demanding treatment and guess what, there's no Tamiflu or it doesn't work. Oopsy!

Actually it could be a whole medical tsumani for which there will be no treatment. Fine if it's low grade flu which for 99% of people causes no long term problems but if not...well we'll be a bit....ahem fucked

What Im confused about is if you are given tamiflu for suspected swine flu, what happens if you actually get swine flu, will they give you more tamiflu?
About a month ago I had swine flu symptoms and was given tamiflu, but ended up going to hospital 4 days into my medication where they told me I had an abscess in my throat.
Now I dont know if I ever had swine flu or if I had tonsilitis that got worse because it wasnt treated properly (they wouldnt see me and diagnosed swine flu over the phone).
Are we only allowed one prescription of tamiflu per person or anytime we have swine flu like symptoms?

You would (I belieev) only get tamiflu once via the voucher issue system. If you had genune need for it at a later date I think that you would still be able to get it - you would just have to have to see a GP to get a second dose ratther than ringing the helpline.

PrefetParfait - I think you are right from what I've heard which seems really stupid because either you didn't have it first time in which case you are risking your GPs health and anyone else at the surgery to go see him/her or the virus has mutated enough or it's virulent enough to overwhelm any immune response in which case I would rather you didn't have to go see a GP when you are probably going to get sicker than last time.

What's worrying me is: I know some people are claiming their free Tamiflu course pre-emptively presuming they will get swine flu at some point and take it then, and when seasonal flu comes out, they will catch that and take the Tamiflu, then get hit with swine flu soon after and what do you know, none left.

Incidentally regarding Tamiflu resistance. I've just been reading up on the whole bird flu thang and when patients were admitted to the hospital with this- the thing that differentiated the ones who survived and the ones who died is that for those who died, the Tamiflu failed to reduce the viral load increasing (Tamiflu works by stopping the replication of the virus within the body) and the virus was resistant within those patients.

There have been cases (two I know of) of swine flu being Tamiflu resistant so far (apparently the two people didn't die but were very sick). Now if say one in a million people who get it, get the version with emerging resistance and they die before that version of the virus manages to be passed on, Tamiflu will eventually become next to useless.
A bit like head lice lotion.

But hey, maybe the vax will work or the virus will just die out on it's own.