Most children who catch swine flu should not be given antiviral drugs, according to researchers, because the risks posed by Tamiflu and Relenza to the young outweigh their benefits.
Researchers from the University of Oxford called on the UK Department of Health urgently to reconsider its pandemic strategy after an analysis of four studies published in the British Medical Journal showed that the benefits for children with seasonal flu were slight.
The review of the evidence showed that one in 20 children given Tamiflu suffered vomiting as a side-effect, which can lead to dehydration and the need for hospital treatment. More than 300,000 people in England have received courses of Tamiflu through the National Pandemic Flu Service since it started last month, with under-15s the worst-affected group.
The scientists said that courses of Tamiflu were unnecessary in almost all cases in children and that widespread use raised the risk of the virus becoming resistant to antiviral drugs.
Carl Heneghan, a general practitioner and clinical lecturer at Oxford, and Matthew Thompson, a senior clinical scientist at the university, said that the government was pursuing an ‘inappropriate strategy’ and that only children with underlying health conditions should be considered for antiviral treatment. Those with mild cases of swine flu should be given paracetamol, fluids and rest, as with any ordinary case of flu, the scientists said.
The authors of the analysis added that parents and GPs needed to remain vigilant in case of complications, while parents of children with a weak immune system, or conditions such as cystic fibrosis, should discuss treatment with their doctors.
Dr. Heneghan said that the only benefit found in the study was that children who took Tamiflu or Relenza were back to normal between half a day and a day earlier.
His advice to GPs was ‘not to rely on Tamiflu as a treatment to reduce complications’ or to think of it as a ‘magic bullet’. The antivirals had little or no effect on asthma flare-ups, ear infections or the likelihood of a child needing antibiotics.
The researchers found that antivirals preventively reduced flu transmission by 8 per cent, meaning that 13 children would have to be treated to prevent one additional case of flu.
Dr Thompson said that while the four studies, of children between the ages of 1 and 12, involved normal seasonal flu, the findings should still be factored in to the approach to swine flu.
Both authors agreed that their analysis should have been a part of Department of Health pandemic planning; the Government should have demanded more data from the pharmaceutical companies including Roche, which makes Tamiflu, and GlaxoSmithKline, which makes Relenza.
Sir Liam Donaldson, the Government’s Chief Medical Adviser, said: ‘This is a good research team and their report is welcome. However, the study is limited in its scope. It reviewed a very small number of past clinical trials on seasonal flu, not the current H1N1 pandemic flu strain. Antivirals are the only available weapon, albeit imperfect, until a vaccine is developed and ready for use.’
A Department of Health spokesman insisted the ‘safety first’ approach was right: ‘For those who experience severe symptoms, the best scientific advice tells us that Tamiflu should be taken as soon as possible. To suggest otherwise is potentially dangerous.’
The findings of the scientists were dismissed by the Department of Health as “questionable” as their review was on seasonal flu and could not be extrapolated to swine flu.