Intended for healthcare professionals

Letters The truth about Tamiflu?

Neuraminidase inhibitors in pandemic A/H1N1 flu

BMJ 2010; 340 doi: (Published 13 January 2010) Cite this as: BMJ 2010;340:c130
  1. J Todd Weber, on assignment from US Centers for Disease Control and Prevention1,
  2. Angus Nicoll, coordinator1,
  3. Carolyn B Bridges, associate director for science2,
  4. Bruno C Ciancio, senior expert1
  1. 1Influenza Programme, European Centre for Disease Prevention and Control (ECDC), 171 83 Stockholm, Sweden
  2. 2Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA

    Jefferson and colleagues describe the effectiveness of neuraminidase inhibitors in otherwise healthy adults infected with seasonal flu virus,1 but it is mainly the A/H1N1 flu virus that is currently in circulation.

    Given the limited availability of vaccine against 2009 pandemic A/H1N1 flu, antiviral drugs have assumed a prominent role in reducing severe flu related morbidity and mortality during the pandemic. Summarised data show benefit from neuraminidase inhibitor treatment in reducing complications, including admission to intensive care and death, among hospitalised patients with A/H1N1 infection.2 These data were collected during the current pandemic in the United States and Mexico without industry funding.3 4 Data from seasonal flu investigations such as that by Lee et al also show a reduced risk of death among hospitalised patients with laboratory confirmed flu who received a neuraminidase inhibitor, even more than 48 hours after the onset of symptoms.5

    The risks associated with the use of neuraminidase inhibitors during the pandemic are being monitored. In the United Kingdom, for example, information has been collected on around a million treatment courses. Adverse effects have not changed, and no new safety concerns have been identified. No evidence has been found of oseltamivir being directly responsible for any death.6

    In the context of 2009 pandemic A/H1N1 flu, the benefits of treatment with neuraminidase inhibitors outweigh the risk of adverse events among people who present with severe disease or who have risk factors for developing severe disease. With vaccination, antiviral treatment remains effective and essential in reducing severe illness and death among patients with 2009 pandemic A/H1N1 flu.


    Cite this as: BMJ 2010;340:c130


    • Competing interests: None declared.


    View Abstract