From all indications, this year’s flu shot was a big disappointment. It was not very effective at preventing influenza infections. But antiviral medications against flu viruses do work. Why have they been overlooked and underused for decades?
A new meta-analysis of nine clinical trials was recently published in The Lancet (online, Jan. 29, 2015). It showed that people given oseltamivir (Tamiflu) got over their symptoms a day sooner and were less likely to develop pneumonia or be hospitalized than people on placebo.
Tamiflu Can Save Lives
Even though this research confirms other findings that Tamiflu saves lives when people have severe influenza infections (The Lancet Respiratory Medicine, May, 2014), doctors still appear reluctant to prescribe it. This mysterious resistance to antiviral flu drugs has persisted for decades.
An editorial in The New England Journal of Medicine (Sept. 2, 1982) encouraged doctors to use the first oral antiviral, amantadine (Symmetrel):
“in an epidemic of influenza, amantadine (Symmetrel) would be indicated for many persons…Perhaps the drug should also be used more widely for the treatment of influenza.”
That never happened. Doctors thought of Symmetrel as a medicine for Parkinson’s disease (its primary indication). They had a hard time wrapping their heads around its use for the flu. They also worried about the insomnia, nightmares and occasional hallucinations that can be adverse reactions to this medication.
A decade later, another antiviral pill was introduced. It was a close cousin to amantadine called rimantadine. The manufacturer came up with a brilliant brand name: Flumadine. Nevertheless, it was not widely prescribed. Doctors just didn’t accept the idea that antiviral drugs could be helpful, and they still haven’t.
Getting an Appointment During an Epidemic
Part of the problem may be logistics. Oral anti-flu drugs should be prescribed only to people who have influenza, but they work best if they are taken within the first two days after symptoms appear.
In the midst of a flu epidemic, getting in to see the doctor takes a lot longer than two days. Many physicians are uneasy writing a prescription for such a medication without seeing the patient, even though that means most of their patients will no longer benefit from an antiviral for the flu because they will have been sick for more than two days.
Basing such a diagnosis on symptoms alone is problematic, because flu-like illnesses are often caused by germs other than influenza viruses. This may be another reason why physicians have been reluctant to adopt antiviral flu drugs.
Rapid Flu Tests
There are rapid flu tests that will reveal in about 15 minutes whether symptoms are actually due to influenza. They are used in doctors’ offices and clinics. Rapid flu test kits need to be sold over the counter so that at the first sign of symptoms, a patient could test himself and let the doctor know if he really has the flu.
Now that research confirms that Tamiflu reduces the likelihood of severe complications, we are optimistic that doctors will be more comfortable prescribing it to their patients with influenza. Readers interested in more details on symptom relief and treatment of viral infections will find them in our Guide to Colds, Coughs and the Flu.
