The Pharmaceutical Journal
Vol 278 No 7439 p180
17 February 2007

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News summary

Threshold triggers antivirals for seasonal influenza

GPs in England have been told to consider prescribing antiviral drugs to at-risk patients who have been in close contact with someone with flu-like symptoms or who have developed flu-like symptoms themselves. The advice comes as surveillance data show that the overall rate of influenza reports has exceeded the threshold at which National Institute for Health and Clinical Excellence guidelines on the use of antiviral drugs are triggered.

In a letter to prescribers, David Salisbury, the Department of Health’s director of immunisation policy, monitoring and surveillance, summarises the NICE guidance, incorporating recent changes to oseltamivir’s licence. He reminds GPs that oseltamivir (Tamiflu) should be prescribed for the prevention of influenza in members of at-risk groups who have not been vaccinated against flu this season (or who were vaccinated too recently to be protected or who received a vaccine that does not match the circulating virus) and who have been in close contact with someone with flu-like symptoms.

Another requirement is that the person must be able to start taking oseltamivir within 48 hours of being in contact with the person with flu-like symptoms. Dr Salisbury points out that since publication of the NICE guidance, which refers to patients aged 13 years and over, oseltamivir has received a licence for prophylactic use in children aged one year and above. “In the interim, until NICE completes its review, it would be appropriate to use oseltamivir for prophylaxis in persons aged 1 year and above according to the other conditions laid out by NICE,” he writes.

Another licence change means that post-exposure prophylaxis is now 10 days as opposed to seven.

In terms of treating flu, prescribers are asked to consider use of zanamivir (Relenza) and oseltamivir but only in those who can start treatment within 48 hours of the onset of symptoms.

NICE does not recommend amantadine for either the prevention or treatment of influenza.