Friday, 24 July 2009

The Week that Was

So its the end of my first week back at work and the Swine Flu panic, er, I mean pandemic is in full swing. We are getting 30-40 patients a day worried they have it. Some do, some don't. Should we be giving them all Tamiflu? Well that depends on what guidelines you read and whether you are bothered by something called evidence-based medicine.

You're no doubt aware of the mountainous piles of Tamiflu the government has stockpiled. Let's get one thing straight. Tamiflu is an antiviral but this doesn't mean its a cure. Its not like taking an antibiotic for pneumonia. At best it will shorten the duration of symptoms by a day. The evidence so far has shown it has no impact on mortality (i.e taking it won't stop you from dying if thats your fate). Its use in a pandemic is unproven.

Lets not forget all the side effects. We are already seeing children who get quite nasty vomiting from it (1 in 10). Trouble is you tell the parents to stop the drug and they shit themselves, convinced that Tamiflu is the only thing stopping their child from knocking on heavens door. So the child vomits themself into dehydration and ends up needing admission.

Interestingly a large study of Tamiflu's potential neuropyschiatric side effects showed a possible increase in seriously abnormal behaviour (such as self-harm) in the under 19s. Its not meant to be used in Japan for this age group such is the number of cases they have had. Of course in this country we have no such qualms in giving it to our children. Tamiflu is classed as a black triangle drug in the UK- this means its a new drug, not all the side effects (or frequency of) are known, or the potential interactions.

One of the high risk groups for complications of Swine Flu is the under ones. The UK has a limited supply of liquid Tamiflu for this group. Guidelines state that all under 1's should be offered the drug. Trouble is is that it doesn't work, no evidence it works and I've been informed via a consultant Neonatologist that the under 1's lack the enzyme to activate it. Also the blood brain barrier hasn't fully formed yet meaning the drug that is known to cause hallucinations and confusion can easily pass into their developing brain. Brilliant. Is that in the press? Hell no, its not even in the Daily Mail which hates all things medical.

Now don't get me wrong. I'm not trying to scaremonger. I'm just letting you know that Tamiflu might make you quite sick, or worse. It lacks evidence of effectiveness and I'd think twice about giving it to anyone under 18.


  1. Interesting read, I will now definitely think twice before giving any of my children Tamiflu, if they happen to get Swine Flu. Thank you for this candid post. :0)

  2. My neighbour had suspected swine flu last week and as her "flu friend" I went to collect Tamiflu for her (as prescribed by her GP). 3 hours later she rang me telling me she felt much much worse and had been very sick. I then had to return to her doctors surgery in order to collect another prescription (presumably for anti-emetics). When I dropped the second prescription off she looked terrible and was clearly confused and very frightened as she was unsure whether it was the drug or the illness making her so sick. In the light of (1) her experience and (2) this blog post, I won't be touching the stuff.

    Thank you for an informative and helpful post.

  3. excellent information. Will avoid Tamiflu, should I be unfortunate enough to catch swine flu. Thank you!

  4. Interesting post.

    Re <1 year olds:
    - v difficult prescribing decision, dut to lack of risk and benefit info
    - oseltamivir needs to be metabolised by hepatic esterases, which are not present in infants aged up to 4 weeks.
    - reference RCPCH statement 6th May 2009

  5. Sorry, wrong link. Amended:

  6. thanks for that helpful link doctor blogs.