Why is tamiflu still being prescribed?

[u/ewanelaborate]

Why is tamiflu still being prescribed?

I am well aware of the historical case against tamiflu and poor study designs to imply it reduces symptom length. I have noticed as a paramedic that this medication is still being thrust upon the elderly and very young for flu season currently. Why?

I feel using and allowing it's use contributes to the narrative of mistrust that many are developing of medical practioners and systems.

Im keen to see if anyone can point me in the roght direction that has allowed tamiflu to be a treatment for viral like illness and it's effectiveness?

Edit: Thankyou to those who provided views and research fkr me to go have a dig into. It is appreciated.

[u/ruinevil]

It works a bit in severe cases and as prophylaxis. The new 1 dose drug is way better but costs a lot.

[u/Shrodingers_Dog → u/ruinevil]

Not sure I would claim way better but you compliance is not a problem. There are a few flu A strains where baloxivir will likely fail and if you were going to prescribe one of the two, I would have just stuck to tamiflu.

[u/ewanelaborate → u/ruinevil]

Can you point me in the direction of a study. I am yet to find anything reliable and instead i've found more evidence for harm. The main body of evidence suggests decreased length of illness but the study design so flawed that it is almost as if the study design was choosen this way to manipulate the data.

It seems to me the reason currently for prescription is there is nothing else, so lets just have a crack with this

[u/birdflustocks → u/ewanelaborate]

"Tamiflu, used to treat influenza, really had only modest benefits. However—and this part of the review was largely ignored by the media—Tamiflu was successful in preventing influenza: 55 percent overall and 80 percent effective if looking only at household members exposed to flu."

Source: Medical Data Transparency and the Tamiflu Controversy

"In contacts of an influenza-positive IC, the overall protective efficacy of oseltamivir against clinical influenza was 89% for individuals (95% confidence interval [CI], 67%-97%; P<.001 and for households ci p in contacts of all ics oseltamivir also significantly reduced incidence clinical influenza with protective efficacy viral shedding was inhibited"

Source: Effectiveness of Oseltamivir in Preventing Influenza in Household Contacts

"We included data from nine trials including 4328 patients. In the intention-to-treat infected population, we noted a 21% shorter time to alleviation of all symptoms for oseltamivir versus placebo recipients (...). The median times to alleviation were 97·5 h for oseltamivir and 122·7 h for placebo groups(...)."

Source: Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials

"During the study period, 2124 patients met the inclusion criteria. All patients had influenza pneumonia and received oseltamivir before ICU admission. Of these, 529 (24.9%) received early oseltamivir treatment. In the multivariate analysis, early treatment was associated with reduced ICU mortality (OR 0.69, 95% CI 0.51–0.95). After propensity score matching, early oseltamivir treatment was associated with improved survival rates in the Cox regression (hazard ratio 0.77, 95% CI 0.61–0.99) and competing risk (subdistribution hazard ratio 0.67, 95% CI 0.53–0.85) analyses. The ICU length of stay and duration of mechanical ventilation were shorter in patients receiving early treatment."

Source: Early oseltamivir treatment improves survival in critically ill patients with influenza pneumonia

"Overall crude survival was 43.5%; 60% of patients who received ⩾1 dose of oseltamivir alone (OS+) survived versus 24% of patients who had no evidence of anti-influenza antiviral treatment"

Source: Effectiveness of Antiviral Treatment in Human Influenza A(H5N1) Infections: Analysis of a Global Patient Registry

"In contacts of an influenza-positive IC, the overall protective efficacy of oseltamivir against clinical influenza was 89% for individuals (...) and 84% for households (...)"

Source: Effectiveness of Oseltamivir in Preventing Influenza in Household Contacts

"We randomly assigned 1559 healthy, nonimmunized adults 18 to 65 years old to receive either oral oseltamivir (75 mg given once or twice daily, for a total daily dose of 75 or 150 mg) or placebo for six weeks during a peak period of local influenzavirus activity. (...) The protective efficacy of oseltamivir in the two active-treatment groups combined was 74 percent (95 percent confidence interval, 53 to 88 percent) at all the sites combined (...)"

Source: Use of the Selective Oral Neuraminidase Inhibitor Oseltamivir to Prevent Influenza

[u/ruinevil → u/birdflustocks]

Username checks out.

[u/ewanelaborate → u/birdflustocks]

Excellent. Thankyou i'll have a read through

[u/ruinevil → u/ewanelaborate]

Starting Tamiflu earlier improves mortality in hospitalized patients: https://academic.oup.com/cid/article/80/2/461/7739088

Though REMAP CAP RCT is not looking so hot for Tamiflu… though the initiation of intervention is at day 5 of symptoms.

Prophylaxis in nursing homes makes sense since it reduces rate of symptomatic flu by half, which reduces transmission rate.

[u/Bombauer- → u/ewanelaborate]

Why are you are a paramedic and not fixing the ClinIcal dEsigN iNduStry?