With the continuing spread of avian H5N1 influenza a possible pandemic of human influenza becomes more likely. If a pandemic started soon no effective vaccine would be available and there would probably be a shortage of antiviral drugs. There is no evidence (yet) of the effectiveness of neuraminidase inhibitors in case of avian and pandemic influenza viruses,1 and mortality among patients infected with H5N1 bird flu remains high, despite the use of neuraminidase inhibitors.2 Resistance to antiviral drugs, which may even develop during treatment, might further limit the efficacy of these drugs.3 Given that secondary bacterial infection is an important and often fatal complication of influenza, antibiotics will also have a critical role in the event of a human pandemic.

In 1918-19, when antibiotics were not available, pandemic flu caused 20 million to 100 million deaths worldwide, with an estimated case fatality rate of between 2% and …