This Flu Rx May Really Work

Oseltamivir for influenza may shorten symptom duration and reduce need for antibiotics and hospitalization

(RxWiki News) Coughing, fever, aches and pains. Flu symptoms can be miserable. Good news, though — a medication may shorten that misery.

An extensive review of research on the medication oseltamivir (brand name Tamiflu) found that it made flu symptoms go away faster. Also, adults who took oseltamivir were less likely to need hospitalization or antibiotics.

The authors of this study said doctors should consider both risks and benefits before using oseltamivir to treat the flu.

"In the flu season, it is important to be aware of early flu symptoms such as fever, body aches and respiratory symptoms," said Steven Davis, MD, an infectious disease specialist at Baylor Medical Center at Irving. "When started early, drugs like oseltamivir can reduce the length of symptoms, reduce risk for secondary complications like infections that may require hospitalization or antibiotics."

Dr. Davis told dailyRx News that another benefit of these types of medications is a possible reduction in secondary transmissions and infections. "This on its own can protect more susceptible persons in the household and community who may be at higher risk for complicated flu," he said.

"This year, the [flu] vaccine has not been as protective as usual against circulating strains due to a mismatch of included strains in vaccine versus commonly circulating strains. So, even if you have been flu vaccinated and you develop flu symptoms, you should seek advice from a physician for evaluation and discuss starting early a drug like Tamiflu," Dr. Davis said.

For this review, Arnold S. Monto, MD, of the Michigan School of Public Health in Ann Arbor, led an independent research group that studied data from nine different trials.

“The safety and effectiveness of oseltamivir has been hotly debated, with some researchers claiming there is little evidence that oseltamivir works," Dr. Monto said in a press release. "Our [research] provides compelling evidence that oseltamivir therapy reduces by one day the typical length of illness in adults infected with influenza and also prevents complications and reduces the number of people needing hospital treatment. Whether the magnitude of these benefits outweighs the harms of nausea and vomiting needs careful consideration.”

The trials Dr. Monto and team studied compared the usual dose of 75 milligrams of oseltamivir to a placebo. A placebo is something like a sugar pill. A placebo has no effects, even though the patient might think it works.

The nine trials Dr. Monto and colleagues studied included more than 4,300 adults with the flu. These trials took place between 1997 and 2001.

These researchers found that patients who had influenza and were treated with oseltamivir got well faster than those who received the placebo. In patients with influenza who were treated with oseltamivir, symptoms went away within 98 hours on average. It took 123 hours for patients treated with a placebo to get well.

Oseltamivir decreased the risk of lung infections requiring antibiotics by 44 percent — compared to the placebo. Antibiotics are medications used to fight bacteria.

In patients with the flu who were treated with oseltamivir, hospital admissions dropped. Patients who took oseltamivir were 44 percent less likely than patients who received a placebo to need hospitalization.

Although oseltamivir was effective, it had side effects. Oseltamivir increased the risk of nausea and vomiting by 3.7 percent and 4.7 percent, respectively — compared to the placebo.

Past research had found some neurological and psychological problems in patients treated with oseltamivir. Dr. Monto and colleagues did not find any differences in these respects in patients treated with oseltamivir and those who received a placebo.

"Many persons are afraid of side effects of Tamiflu, but the frequency of side effects noted compare favorably to frequency of side effects seen with common antibiotics and even some over-the-counter medications," Dr. Davis said. "Previously, persons had concerns about neurological or psychiatric effects of oseltamivir, but no increase in these were seen over placebo in this large meta-analysis. Certainly high fevers in the flu can be associated with short-term mental status change unrelated to medications."

People can protect themselves from the flu. They should limit contact with people who are sick and stay home if they get sick, recommends the Centers for Disease Control and Prevention. They should also wash their hands often, eat a healthy diet and get enough rest.

People should also speak to their doctors about whether they should get the flu vaccine. People who think they may have the flu should seek treatment as soon as possible — medications like oseltamivir often work best if taken early on.

This study was published online Jan. 30 in The Lancet.

The Multiparty Group for Advice on Science Foundation funded this research through an unrestricted grant from oseltamivir manufacturer Roche Pharmaceuticals. Dr. Monto received fees from Roche for work outside this study. Study author Dr. Richard J. Whitley received travel funding from Roche for work outside this study, as well as fees from Gilead Sciences for board member services.

Review Date: 
January 29, 2015