GPs are told to treat with scepticism advice on anti-flu drugs from Public Health England

GPs in three English counties have been told to be wary of advice from Public Health England (PHE) to prescribe oseltamivir (Tamiflu) prophylactically to nursing home residents, because of a lack of evidence that the drug is useful in such circumstances.

Paul Roblin, CEO of the medical committee representing GPs in Berkshire, Buckinghamshire, and Oxfordshire, has written to GPs in his area to warn of insufficient evidence for use of the drug in people without symptoms, after GPs raised concerns that they felt bullied by local PHE representatives into prescribing the drug as a preventive measure. Roblin said that guidance from the National Institute for Health and Care Excellence (NICE), which recommends using oseltamivir prophylaxis to prevent influenza in nursing homes, fails to consider unpublished data and reflects publication bias.

At the end of last year the Department of Health gave GPs the go ahead to prescribe antiviral drugs as circulating levels of influenza began to increase. This came after a letter to doctors from Paul Cosford, director of health protection at PHE, which said, “PHE continues to support the early use of antivirals for patients with proven or suspected seasonal influenza who are in high risk groups or who are considerably unwell.”

However, Roblin questioned this advice. “Prescribing preventatively to [well people] must surely involve an individual conversation on the risk/benefits ratio and mental capacity assessment as well as renal function. This can …