Policy on antiviral drugs needs to be revised …

UK swine flu policy recommends antiviral agents for febrile patients with two or more symptoms of flu-like illness, up to seven days from onset.1 Thus, even with comparatively low rates of flu-like illness, many people are prescribed antiviral agents. We lack a clear evidence base that this policy is effective in clinical, public health, and economic terms, and that we are not unnecessarily exposing many people to drug treatment, with the risk of side effects.2 We should consider acting as we do during seasonal flu, similar to Australian policy.3

The high volume of work (reporting, testing, and organising treatment for so many people) has meant that few cases have had treatment within 48 hours. If antiviral drugs cannot be given in time to reduce illness, then the only possible benefit is a possible reduction in viral shedding, and therefore a possible reduction in the risk of infection to others. While neuraminidase inhibitors may reduce viral shedding,4 we are unaware of any evidence that this adds significantly to advice on self isolation and hygiene.

By using antiviral drugs so liberally—for what is currently a mild form of flu—we risk generating resistance so that when a more virulent form of flu presents the drugs may no longer be effective. The current policy is probably doing more harm than good, even without taking into account the enormous resource implications, the important work left undone as general practitioners and others focus their efforts on swine flu, and the loss of staff goodwill. We question the need to continue the use of antiviral drugs for people who are not in at risk groups.