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Steroids good in sore throat, Tamiflu not that good in swine flu

Ami Banerjee
Last edited 17th March 2010

It has been difficult to resist blogging about swine flu as the furore surrounding the pandemic has grown over the last four months, but I am finally giving in to temptation. Recently, the estimated new cases of swine flu per week fell from 110,000 to 30,000 in England. The government has stuck by its policy of offering antivirals to anyone infected and has stockpiled Tamiflu, but it now appears that this strategy may be unhelpful in children. The UK Department of Health has moved from the “containment” phase to the “treatment phase”, recommending antiviral treatment in “at-risk groups, “…defined as those who are at higher risk of serious illness or death should they develop influenza,” including children under the age of 5.

A meta-analysis by members of Oxford’s Centre for Evidence-Based Medicine studied the seven randomised trials of Tamiflu (oseltamivir) and Relenza (Zanamivir) in seasonal flu in children, and has shown that Tamiflu probably has no role in children. Although none of the trials looked specifically at swine flu, the authors concluded that the H1N1 virus was unlikely to be that different. Importantly, there was no added benefit of use in Tamiflu in children with asthma, a population defined as high-risk by the Department of Health. Conversely, Tamiflu increased the risk of vomiting in already sick children. Their bottom line for treatment was that Tamiflu reduced the course of flu by 1 day (on average) in an illness that usually last 7-10 days. Their bottom line for prevention was that a 10-day course of Tamiflu propylaxis reduced the risk of flu by 8%, meaning that 13 children need to be treated to prevent 1 case of flu. “In the current pandemic, there is a pressing need to understand the benefits and potential adverse effects of these drugs as the current evidence base supporting this age boundary is limited.” That’s an understatement if ever I heard one.

The CEBM boys and girls have also been busy doing another meta-analysis in this week’s BMJ, but this time looking at the role of steroids in sore throat in adults and children. An evaluation of 8 trials including 750 patients showed that steroids increased the chance of complete resolution of pain at 24 hours by three-fold, particularly in severe throat infections. It seems we sometimes can’t see the wood for the trees when it comes to drugs. We are much more likely to trial complex, expensive therapies than simple, older, and often more effective treatments, which might actually save the National Health Service some money.


Rather than evidence-based medicine, we seem to have "must be seen to be doing something" medicine?



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