Viral resistance and poor efficacy make neuraminidase inhibitors Relenza and Tamiflu questionable except in severe cases of influenza Unfortunately they are being stocked like panaceas.
Relenza and Tamiflu are known as neuraminidase inhibitors (NIs). Two other, older flu drugs, amantadine and rimantadine, are now of little use because flu viruses have become resistant to them over the years.
The Cochrane review, carried out in 2006 but regularly updated, most recently this year, says the NIs do not stop people becoming infected, although they do decrease the amount of virus sprayed from people's noses when they sneeze all over you in the bus or office. They can also reduce the complications of flu, such as bronchitis and pneumonia. The review concluded that they might be of some help in a pandemic, but strongly recommended they should not be handed out routinely or used for normal winter flu outbreaks.
To Jefferson's horror, however, the WHO has recommended that the drugs should be used against seasonal flu - the usual forms of flu that hit us every winter - so that doctors get used to giving them, and patients to taking them, ahead of a pandemic. "Wide-scale use of antivirals and vaccines during a pandemic will depend on familiarity with their effective application during the inter-pandemic period," it reasons.
Luby carried out a randomised trial in squatter settlements in Karachi, promoting hand-washing in half the families. Children under five who regularly washed their hands had half as many episodes of diarrhoea, impetigo and acute respiratory infection. It saved lives. If the big pandemic hits, washing hands will save more lives than Tamiflu, he predicts.
http://www.guardian.co.uk/world/2009/may/07/tamiflu-swine-flu-drugs
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