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

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h258 (Published 15 January 2015) Cite this as: BMJ 2015;350:h258

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

There can be no doubt that influenza can have a very serious impact on ill and vulnerable members of our society. It can spread rapidly within communities, the treatment of severe influenza can be challenging and the therapies available are limited. The public health emphasis is therefore on prevention and control.

Although the influenza vaccine offers individual protection, this may be sub-optimal for some groups, such as the elderly or those with underlying conditions (such as immunosuppression), who are at risk of severe outcomes following infection. Chemoprophylaxis may be offered to those in at risk groups with known exposure to influenza to reduce the risk of infection and such complications. In December 2014, following Public Health England (PHE) advice, the Chief Medical Officer issued guidance to all GPs on the use of antiviral drugs for the treatment and prophylaxis of influenza, as per NICE guidance for the use of antivirals once influenza is circulating in the community. However, we are aware that in one local area, the contractual arrangements for the prescription of antivirals in nursing homes have been disputed and as a consequence prophylaxis has been denied to this vulnerable group.

There is now convincing evidence and analysis to support the post exposure use of antiviral prophylaxis in certain circumstances. Although the often cited Cochrane review did not find any effect of antivirals on influenza-like symptoms, it did find that the post exposure use of antivirals was associated with a significant reduction in the risk of lab-proven symptomatic influenza with a risk ratio of 0.45 (a 55% reduction in risk). The same review also states that when oseltamivir prophylaxis was used in cases of known exposure within a household, a situation akin to that in care homes, the risk reduction increased to 80%. The other available antiviral, zanamivir, when used prophylactically was associated with a significant reduction in pneumonia (RR 0.30); the effect was not analysed for oseltamivir. It is therefore concerning that in the face of evidence from the Cochrane Review, NICE and PHE, family doctors are reluctant to prescribe therapies that may prevent their patients from becoming unwell or that could prevent significant morbidity and mortality due to influenza.

PHE continues to recommend the use of antivirals as prophylaxis to control influenza outbreaks in vulnerable patient populations such as nursing homes, in line with NICE Guidance (TA158). It also continues to recommend the early use of antivirals for treating patients with proven or suspected seasonal influenza who are in high risk groups or who are considerably unwell.

Competing interests: No competing interests

16 January 2015
Professor Nick Phin
Interim Director for the Centre for Infectious Disease Surveillance and Control
Dr Rachel Moll
Public Health England