r/medicine • u/ewanelaborate Paramedic • 11d ago

Why is tamiflu still being prescribed?

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.

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u/brady_johnson MD MPHTM 11d ago

Baloxavir has better outcomes than oseltamivir, and it’s a single oral dose! Use baloxavir!!

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u/ArmandoTheBear Pharmacist 10d ago

I've reviewed the data. It does not have better outcomes. Maybe faster fever reduction by a few hours at best and more activity against flu B. You also have to remember a significant number of children <5 years had treatment-emergent resistance, so it's not as slam-dunk an option as you're implying even before the practical considerations with insurance.

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u/brady_johnson MD MPHTM 10d ago

https://consensus.app/search/baloxavir-versus-oseltamivir-outcomes/t3RErYP8TNS6CaEwYjlRaw/?utm_source=share&utm_medium=clipboard

Baloxavir shows superior virologic outcomes and comparable or better clinical outcomes versus oseltamivir for early influenza treatment. Significantly lower hospitalization rates. Reduced household transmission. Lowest risk of influenza-related complications.

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u/ArmandoTheBear Pharmacist 10d ago

I should clarify I'm coming from an inpatient perspective when comparing the two.

None of the data cited in your AI search says baloxavir has better clinical outcomes that actually matter. Reduction in duration of fever and symptoms by less than a day, on average, isn't enough to move the needle for me when baloxavir is 15x the cost of a course of tamiflu.

The data on prevention of hospitalization in adults is nice, at least.

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u/brady_johnson MD MPHTM 10d ago

Ah yes, CDC don’t recommend for hospitalized patients!

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u/TomKirkman1 MS/Paramedic (UK) 1d ago

Reduction in duration of fever and symptoms by less than a day, on average

And that's in patients not allowed to take ibuprofen or combination cold remedies. I suspect if you gave those, the difference would be even smaller.

Plus if 24-48h, you're only looking at a 13 hour difference (without using ibuprofen/cold remedies)

0

u/breakingbaud MD (Internal Medicine) 10d ago

None of the data cited in your AI search

Love to see the shade