Is Tamiflu for You?

[Sensei]

It is about that time of year: peak influenza season. Well, we may have experienced the peak a couple of weeks ago, but this year is shaping up to be a doozy in terms of the flu. My state has seen at least 50 deaths due to the flu, but this is likely an underestimate as the antigen detection methods at your doctor's office suck. Anyway, I thought that this might be a good chance to give you my semi-educated (I'm not an ID specialist) take on the flu, related illnesses, and the current science behind the treatments.

First, influenza is a viral, respiratory illness that is common in the late Fall through late Winter. Characteristic symptoms are fever, body aches, headache, cough and congestion. The incubation is about 2 days and the disease is spread predominantly through respiratory droplets. Infected individuals shed virus for about 24 hours prior to the onset of symptoms and remain contagious for about a week (kids longer). Influenza covered snot persists on surfaces, so wash your hands frequently and keep them away from your face.

Influenza is a world of suck for the first 72-96 hours of illness, but it is rarely fatal. Complications that require hospitalization mainly occur in the elderly or infants. Having said that, I see one or two young, healthy patients every year who crash and burn in the ICU from adult respiratory distress syndrome (ARDS) brought on by influenza +/- bacterial pneumonia. This year's seasonal flu is significantly worse than last year due to the predominance of an unpredicted strain, H3N2, that is poorly covered by the vaccine and associated with more severe illness in the extremes of age.

Treatment for most people is mainly supportive with hydration, decongestants, and antipyretics/analgesics. I generally recommend 400 mg of motrin every 6 hrs and 650 - 1000 mg of tylenol every 8 hours for the fever and body aches. Oral hydration is best achieved with Pedialyte even in adults; this is especially effective if you have vomiting or diarrhea associated with your illness or as a side-effect of treatment (see below). Sports drinks and sodas are less ideal since they are not isotonic to serum, may have a diuretic effect due to caffeine, and the sucrose load may contribute to an osmotic diarrhea.

For the past decade or so, Tamiflu (oseltamivir) has been studied and marketed as a treatment for influenza A and B. There is a significant amount of controversy surrounding the approval of this drug, the marketing, government conflict of interest, cost, and side effects. The manufacturer, Genentech, has been criticized for not releasing all of the negative data when Tamiflu was being consider by the FDA. The preliminary studies suggested that Tamiflu would shorten the illness by about a day at the cost of about $120. A more insidious cost is the less talked about side effects which include nausea/vomiting/diarrhea (common) and delirium/psychosis (rare). In addition, a 2014 Cochrane review of ALL the data released by Genentech found that Tamiflu was less effective that previously thought, and only reduced symptoms by 1/2 a day. Moreover, it had zero effect on hospital admission or complications on this secondary review. You can read more on this review in layman's terms here: http://www.cochrane.org/features/tam...tive-are-they?

So, do I use Tamiflu? Rarely. Despite the mounting evidence against its use, the CDC still recommends it likely due to the government's decision to stockpile the drug at a cost of $1.5 Billion. Its use is in such common practice that I'd have an uncomfortable experience on the M&M podium explaining to my colleagues why I didn't use it in a crumping patient. Having said that, I do not recommend this drug for anyone who is healthy with the flu. Drink your Pedialyte, wash your paws, take your motrin, and save your $120 for ammo...

[JDM]

Fantastic content. Thank you!

I contracted the flu a few years ago and was prescribed tamiflu for the first time in my life despite contracting influenza a few times before. My experience mirrored what you wrote here...it did very little to improve my condition.

In the future, I'll pass and tough it out.

[Paul D]

Excellent post. I tell my patients that during winter, tis the season to be antisocial....no hugging snot nosed kids, minimize the handshakes and in public places learn how to operate all doors and appliances with your foot.

[LSP552]

Thanks Sensei, but you are two weeks too late for me.

I'm one of the lucky ones who contracted A strain flu despite having my flu shot. My doc prescribed Tamiflu. Guess I was lucky, no real side effects and it did seem to lesson the symptoms after about 24 hours. I was pretty miserable for a week. This time seemed much worse than the last time I had the flu…..course I wasn't 59 then either.

[LSP552]

Excellent post. I tell my patients that during winter, tis the season to be antisocial....no hugging snot nosed kids, minimize the handshakes and in public places learn how to operate all doors and appliances with your foot.

Yep….my 7 year old grandniece passed A strain on to me.

[SeriousStudent]

This is very useful. Thank you for taking the time to post it. I'll pass it on to the minions at work also.

[Suvorov]

Probably a stupid question - but would you advise the flu shot at this point if I haven't already done so?

[RoyGBiv]

How about flu shots?
We get them religiously every September.

I carried a course of Tamiflu on my Asia excursions for several years when SARS was making headlines. Never had a reason to take it.

And the "universal flu vaccine " made some headlines last week. ??

[Sensei]

Thanks Sensei, but you are two weeks too late for me.

I'm one of the lucky ones who contracted A strain flu despite having my flu shot. My doc prescribed Tamiflu. Guess I was lucky, no real side effects and it did seem to lesson the symptoms after about 24 hours. I was pretty miserable for a week. This time seemed much worse than the last time I had the flu…..course I wasn't 59 then either.

Overall, your risk of a side effect is low: about 5% will get a GI symptom and 1% get a behavior disturbance from Tamiflu.

A more common problem is the over prescription of antibiotics for fancy sounding viral illnesses. For example, there is zip, zero, nada evidence that antibiotics are beneficial in the vast majority of illnesses labeled as bronchitis, sinus infections, or upper respiratory infections. These illness are most often viral or effectively cleared by host immunity in the vast majority of bacterial cases. Now, there are some notable exceptions such as people with pneumonia, impaired immunity, structural lung / respiratory disease (pulmonary fibrosis, COPD, sarcoidosis, pharyngeal tumors, etc.) who do benefit from antibiotics. However, there is a much higher incidence of adverse reactions than clinical improvement associated with the use of antibiotics in healthy people who really have what amounts to a bad head or chest cold.

[DiscipulusArmorum]

I've never been on the stuff, but just the other day I saw a commercial for Tamiflu that made minor mention of that "reduces symptoms by one day" claim toward the end, and I was blown away that that was considered significant enough to try and get people to pony up the money for a brand name drug (practically no drug with a TV commercial is going to be cheap) and risk the side effects. Granted, I'm sure when you're in the throes of a nasty flu, even half a day less of suffering might seem like a godsend.