INFLUENZA PANDEMIC (H1N1) 2009 (29): CHILD TREATMENT

Date: Tue 11 Aug 2009
Source: The Globe and Mail [edited]
<http://www.theglobeandmail.com/news/national/tamiflu-effective-in-treating-children-canada-maintains/article1247247/>


Canada dismisses warning about flu drug
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Canadian health authorities will not change their practice of prescribing
the antiviral drug Tamiflu [oseltamivir] to treat cases of influenza
pandemic (H1N1) 2009 virus infection in children, despite a new study that
raises questions about the drug's effectiveness [see: Influenza pandemic
(H1N1) 2009 (28): child treatment 20090811.2859]. Researchers at the
University of Oxford cautioned about the broad use of antiviral drugs to
treat children 12 years of age and younger suffering from seasonal flu.
They found antiviral drugs have little or no effect on asthma flare-ups,
ear infections, or bacterial infections in children. Tamiflu was also
linked to increased vomiting. The authors questioned whether children would
face the same risks when being treated with antivirals for the pandemic
(H1N1) 2009 virus.

But the Public Health Agency of Canada assured parents on Monday (10 Aug
2009) that Tamiflu has a strong safety profile, and has recommended doctors
prescribe it for infection prevention and to treat cases of H1N1 in infants
under one year. "We know that Tamiflu thus far is effective in treating the
vast majority of people who have H1N1, making their symptoms less severe
and the illness lasting fewer days," the agency said in an email. "We now
have some evidence that there seems to be less risk in using Tamiflu in
young children." The pandemic virus has shown resistance to Tamiflu, one of
2 antivirals that can keep it in check if taken within days of the 1st
symptoms. However, there have been people who have fallen ill despite
taking the drug.

The study, published on Monday in the British Medical Journal, found
antivirals shortened the duration of seasonal flu in children from between
a half-day and 1 1/2 days. But the study found no clear evidence the
antivirals prevent complications in children with seasonal flu. It didn't
prevent asthma exacerbations in asthmatic children nor lower rates of
antibiotic prescriptions, for example.

The researchers did not study the effects of antivirals on children with
pandemic (H1N1) 2009 virus infection, but said that based on some evidence,
antivirals might have "limited" effects on preventing complications. "While
morbidity and mortality in the current pandemic remain low, a more
conservative strategy might be considered prudent, given the limited data,
side effects such as vomiting, and the potential for developing resistant
strains of influenza," Matthew Thompson, a senior clinical scientist at
Oxford, and his colleagues concluded.

The researchers conducted a scientific review of 7 previous studies, known
as a meta-analysis, on the use of antiviral drugs for seasonal flu in
children. 4 studies looked at the treatment of influenza, the other 3
looked at the use of drugs to prevent infection. Grant Stiver, a professor
of medicine in infectious diseases at Vancouver General Hospital and the
University of British Columbia, dismissed the findings. "I don't think I
would base any clinical judgment on this study," Dr Stiver said in an
interview. Trials done on Tamiflu have shown the drug to have benefits when
it comes to seasonal flu, even in children, he said. Although there isn't
much data on antivirals and the pandemic (H1N1) 2009 virus, Dr Stiver said
Tamiflu helps prevent the spread of infection in the early stages and, more
importantly, in the absence of a vaccine. "I think it's safe in children,"
Dr Stiver said. "The earlier you can get this drug, the better it works."

[byline: Caroline Alphonso]