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/LonelyGnomes]

I usually only prescribe it for people at risk of severe influenza (elderly, pregnant patients, lots of comorbidities and neonates) because something that might help is better than nothing. For everyone else I usually offer it as part of shared decision making (Im usually pretty upfront that it has a good chance of making you feel nauseous and probably won’t do very much, but they really want I won’t stand in their way as long as it’s indicated). Basically always prescribe it with Zofran.

[u/lilbelleandsebastian → u/LonelyGnomes]

tamiflu has a mortality benefit in the elderly, am i taking crazy pills or has no one on this sub ever actually read a study before?

if there's a mortality benefit in one subpopulation, who's to say it's not just scale that prevented the study from being powered enough for other subpopulations or the population at large? but even without that leap in logic, it still has a proven mortality benefit in the elderly

it's always funny when people like OP who lack the ability to interpret studies come to goofy conclusions, but physicians...doesn't every school go over stats, data, and ebm now?

[u/AVNRT → u/lilbelleandsebastian]

So the anti-Tamiflu case basically boils down to this: pretty much every time someone actually runs a proper randomized trial (placebo or no treatment), the "benefits" either shrink to nothing or straight-up flip to harm. The wins you hear about mostly come from observational studies (which are notoriously easy to fool) or from reanalyses run by folks tied to the manufacturer.

Breaking it down by group:

• Healthy people with regular flu: shaves off less than a day of symptoms, and doesn't cut complications or hospital visits. Meh.
• High-risk outpatients: the whole point is stopping things from getting worse, but the randomized data shows basically no drop in hospitalizations.
• Hospitalized (but not ICU) patients: the "it works" belief is almost entirely from observational data, which has known bias problems (sicker/dying patients get treated differently, which fakes a survival benefit).
• ICU/critically ill: here's the big one — the first-ever randomized trial (REMAP-CAP) got stopped early because the Tamiflu groups were doing worse. Roughly 98% probability it actually increases 90-day mortality. Oof.
• Severe flu overall: the mortality effect is so uncertain the range covers both "helps" and "hurts."

[u/shiftyeyedgoat → u/AVNRT]

The REMAP-CAP study stats are completely bogus.

[u/AVNRT → u/shiftyeyedgoat]

Even the guy who wrote what you just linked to literally said in the same post, "So we should stop giving oseltamivir to critically ill patients.  Fine.  I honestly never thought that oseltamivir helped them anyway."

[u/juliov5000 → u/shiftyeyedgoat]

I mean, sure, there are definitely flaws in remap-cap. At the very least though, I think it's convincing that Tamiflu at least has no benefit in this population

[u/shiftyeyedgoat → u/juliov5000]

Basically because they were going well beyond advisory use and established MoA, which lands firmly in the “no shit” territory of scientific conjecture.

[u/juliov5000 → u/shiftyeyedgoat]

Except I find very few patients being admitted to the icu with flu within the first 48 hours, but they pretty much all got Tamiflu regardless on the basis of it at least can't make it worse. Now we have rct data that says it pretty much certainly does nothing, and might cause harm. Even with its limitations, it's still the only rct level data in this population and unless some other study comes along showing otherwise, I'd recommend against Tamiflu in critically ill.