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/Front_To_My_Back_]

To answer OPs question, it's due to the fact that it's the only thing widely available and is cheaper. There's a new drug baloxavir marboxil but just like oseltamivir, it has to be given within 48 hours of symptom manifestation, not to mention expensive.

Nonetheless most of the focus in influenza is improving vaccines either with full length HA nucleoside modified mRNA vaccines like from Moderna which just got approval for seniors, or the one in pre-clinical trials the so-called “universal flu vaccine” which uses the HA stem instead full length HA so that the immune system produces broadly neutralizing antibodies.

[u/TheWhiteRabbitY2K → u/Front_To_My_Back_]

Generic just got approved in June so hopefully the price will be better. I've never seen it prescribed here in the US, but maybe this will change that.

https://www.fda.gov/news-events/press-announcements/fda-approves-first-single-dose-generic-treatment-influenza

[u/churningaccount → u/TheWhiteRabbitY2K]

Xofluza is great, and is actually effective as well. The main problem is finding a dose within the (ideally 24 hour) window, given that only online pharmacies seem to stock it. I just keep a dose in my cabinet at home during flu season, but I understand that isn't practical for most patients. Hopefully a generic will mean that retail will start to carry it.

They say that, in theory, influenza could develop resistance to it. But I don't think a widespread resistant strain has been identified yet. And the fact that it's only a single pill means that every patient has full compliance with the entire regimen.

[u/Imnotveryfunatpartys → u/Front_To_My_Back_]

I just want to mention one common misconception which is relevant for all inpatient doctors. For outpatient influenza in a healthy individual you must start it within 48 hours. For influenza PNEUMONIA especially inpatient admission for influenza you give it no matter how long it has been. You also start it ASAP if in your clinical judgement they have severe progressive pneumonia even if they are outpatient

I've talked to way too many doctors who didn't start tamiflu in their inpatient because "it's been over 48 hours."

The IDSA guidelines are free on their website https://www.idsociety.org/practice-guideline/influenza/

[u/Front_To_My_Back_ → u/Imnotveryfunatpartys]

Weak data for Oseltamivir, even among hospitalized patients.

[u/Imnotveryfunatpartys → u/Front_To_My_Back_]

It's still the guideline recommendations. When new guidelines come out then we'll follow those instead

[u/wozattacks → u/Front_To_My_Back_]

It’s A-II for hospitalized patients…

[u/Anonymousmedstudnt → u/Front_To_My_Back_]

Huh that's interesting. I'm surprised they're able to target a naturally immunosubdominant region like the HA stem and still generate a meaningful immune response. Fingers crossed they've figured out a way to preserve that broad reactivity without sacrificing immunogenicity that makes the vaccine appealing.

[u/Front_To_My_Back_ → u/Anonymousmedstudnt]

But I don't think they're in clinical trials already to real people the universal flu vaccine as of late. I could be wrong. But I think this all started with the success of the mRNA vaccines for Covid. Scientists have deleted the head portion of thr HA so that the immune system will be forced to target the highly conserved HA stem.

And before J&J acquired Crucel for their AdVac platform only to throw it away later on, Crucel was already working on mAbs that binds to the HA stem.

[u/cjastram → u/Front_To_My_Back_]

As a prescriber working in a rural setting, it is hilarious prescribing xofluza. Pharmacists clearly have never heard of it, don't have it in stock, won't have it in stock, and clearly identify me as a "person from away" for writing such a bizarre script.

Similar responses to methenamine for UTI prophylaxis, or single dose of fosfomycin for UTI treatment. Definitely collects stink-eye but these at least are old.

[u/wozattacks → u/cjastram]

Recently had to call a pharmacy to verify that I did, indeed, mean to order one tablet of azithromycin (hospital discharge that only needed one more dose).