We need a randomised trial of antiviral therapy for pandemic flu
Sir, Shun-Shin and colleagues have reported that the effects of
neuraminidase inhibitors in children with confirmed seasonal flu are
similar to those observed in adults, symptoms are shortened by about one
day with no proven effect on complication rates but there is a 5%
additional risk of vomiting in children.(1,2)
The letter from Sherine Thomas and colleagues (above) reports that
less than 10% of those admitted to an Infectious Disease unit with
suspected pandemic flu actually had this illness and the letter by
Williams and McCarron in the same issue of the BMJ reported that only 2 of
28 patients admitted to an isolation ward with suspected pandemic flu
actually had this condition whilst vulnerable patients with conditions
such as asthma, bronchiectasis and pneumonia were placed at increased risk
by being admitted to a ward where two patients with pandemic flu were
being nursed.(3) The diagnostic rate in the community would presumably be
even lower.
If antiviral drugs have the same effect on pandemic flu as on
seasonal flu, the above evidence suggests that treating 100 patients with
suspected pandemic flu would result in fewer than 10 patients having their
length of symptoms shortened by about one day and up to five patients may
vomit (especially younger patients).
The UK Department of Health has stated that antiviral therapy will be
given to suspected cases of pandemic flu “as a safety measure”. As the
benefits of antiviral therapy in pandemic flu are unknown, it would surely
be better and more ethical to conduct a randomised controlled trial of the
effects of antiviral therapy on the present strain of pandemic flu. As the
numbers affected are large and the time course of illness is short, the
results of such a trial could be available in a matter of weeks.
1. Shun-Shin M, Thompson M, Heneghan C, Perera R, Hamden A, Mant D.
Neuraminidase inhibitors for treatment and prophylaxis of influenza in
children: systematic review and meta-analysis of randomised controlled
trials. BMJ 2009; 339: b3172
2. Burch J, Corbett M, Stock C, Nicholson K, Elliot AJ, Duffy S,
Westwood M, Palmer S, Stewart L. Prescription of anti-influenza drugs for
healthy adults: a systematic review and meta-analysis. The Lancet
Infectious Diseases 2009 DOI:10.1016/S1473-3099(09)70199-9
3. Williams J, McCarron B. A/H1N1 Pandemic, Case definition is too
loose. BMJ 2009; 339:415
Competing interests:
None declared
Competing interests:
No competing interests
26 August 2009
B Ronan O'Driscoll
Consultant Respiratory Physician
Peter M Turkington
Salford Royal University Hospital, Salford, M6 8HD
Rapid Response:
We need a randomised trial of antiviral therapy for pandemic flu
Sir, Shun-Shin and colleagues have reported that the effects of
neuraminidase inhibitors in children with confirmed seasonal flu are
similar to those observed in adults, symptoms are shortened by about one
day with no proven effect on complication rates but there is a 5%
additional risk of vomiting in children.(1,2)
The letter from Sherine Thomas and colleagues (above) reports that
less than 10% of those admitted to an Infectious Disease unit with
suspected pandemic flu actually had this illness and the letter by
Williams and McCarron in the same issue of the BMJ reported that only 2 of
28 patients admitted to an isolation ward with suspected pandemic flu
actually had this condition whilst vulnerable patients with conditions
such as asthma, bronchiectasis and pneumonia were placed at increased risk
by being admitted to a ward where two patients with pandemic flu were
being nursed.(3) The diagnostic rate in the community would presumably be
even lower.
If antiviral drugs have the same effect on pandemic flu as on
seasonal flu, the above evidence suggests that treating 100 patients with
suspected pandemic flu would result in fewer than 10 patients having their
length of symptoms shortened by about one day and up to five patients may
vomit (especially younger patients).
The UK Department of Health has stated that antiviral therapy will be
given to suspected cases of pandemic flu “as a safety measure”. As the
benefits of antiviral therapy in pandemic flu are unknown, it would surely
be better and more ethical to conduct a randomised controlled trial of the
effects of antiviral therapy on the present strain of pandemic flu. As the
numbers affected are large and the time course of illness is short, the
results of such a trial could be available in a matter of weeks.
1. Shun-Shin M, Thompson M, Heneghan C, Perera R, Hamden A, Mant D.
Neuraminidase inhibitors for treatment and prophylaxis of influenza in
children: systematic review and meta-analysis of randomised controlled
trials. BMJ 2009; 339: b3172
2. Burch J, Corbett M, Stock C, Nicholson K, Elliot AJ, Duffy S,
Westwood M, Palmer S, Stewart L. Prescription of anti-influenza drugs for
healthy adults: a systematic review and meta-analysis. The Lancet
Infectious Diseases 2009 DOI:10.1016/S1473-3099(09)70199-9
3. Williams J, McCarron B. A/H1N1 Pandemic, Case definition is too
loose. BMJ 2009; 339:415
Competing interests:
None declared
Competing interests: No competing interests