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Should we treat flu?

Posted on 3 March 2009

Review questions use of antivirals to treat healthy adults with seasonal flu

Use of antiviral drugs for the treatment of people presenting with symptoms is unlikely to be the most appropriate course of action during a seasonal outbreak suggests a new systematic review published ahead of print in the journal Lancet Infectious Diseases.

This systematic review was led by researchers from the Centre for Reviews and Dissemination at the University of York. The aim was to assess the effectiveness and cost effectiveness of drugs used to treat seasonal influenza in both healthy and ‘at-risk’ individuals (e.g., people with lung or heart diseases, diabetes, or other health problems).

The systematic review combines data from 26 trials and represents the most comprehensive and robust review to date. Although the review is based on data for seasonal flu, the authors say the findings could have relevance for the current H1N1 pandemic.

The review found that when compared to placebo, on average zanamivir (relenza) or oseltamivir (tamiflu) reduced the time to alleviation of influenza symptoms by approximately half a day in otherwise healthy adults. For people considered ‘at risk’ of influenza-related complications, the time to alleviation of symptoms was reduced by up to one day. These reductions in symptoms are relatively small in the context of the overall length of symptoms for most patients.

There were insufficient data available from which to draw conclusions regarding the potential of either zanamivir or oseltamivir to reduce the incidence of complications such as bronchitis or pneumonia.

In discussing the findings the authors conclude: “Although the evidence for clinical effectiveness in healthy and at-risk populations is similar, and the data relating to complications is lacking in both groups, it is reasonable to recommend precautionary treatment to people who are at an increased risk of suffering influenza-related complications.”

Dr Jane Burch said that “Even if active management of seasonal influenza in healthy adults was deemed a public health priority, recommending the use of antiviral drugs for the treatment of people presenting with symptoms is unlikely to be the most appropriate course of action.”

The authors also state that an extension of the vaccination policy to all working-age adults might be a more appropriate choice for healthy adults, but the cost-effectiveness of this strategy has yet to be investigated.