Swine Flu Treatment Update | Pandemic Preparedness

WHO says healthy children over five don’t need Tamiflu

New WHO guidelines for the pharmacological treatment of pandemic H1N1 recommend that healthy children with swine influenza not be given Tamiflu.
The medication, which continues to represent the mainstay of treatment for the illness, should be administered only if the sick child

• develops a severe form of swine flu;
• starts deteriorating;
• has an underlying medical condition, like asthma or diabetes; or
• is under the age of five.

Children who require treatment should be given Tamiflu immediately. Those with underlying conditions or under five years of age should be treated as soon as possible, even if they have mild symptoms.

Evidence-based recommendations

The WHO says the new guidelines, issued August 20, 2009, have been developed keeping in consideration the results of two studies that recently raised doubts about Tamiflu’s safety in children. The findings had been published early this month in the British Medical Journal by researchers of Oxford University, UK, led by Dr. Matthew Thompson.

Thompson’s team found that children on Tamiflu not only experience slight benefits–those who receive the drug recover up to one day earlier than those who don’t–one in 20 also suffer from side effects like vomiting, which may lead to potentially life-threatening conditions like dehydration. What’s more, treatment with Tamiflu seems ineffective in reducing the occurrence and/or severity of ear infections, asthma flare-ups or the need for antibiotics. In other words, say the researchers, the risks associated with Tamiflu outweigh the benefits; therefore, widespread use of the drug in children in unjustified and potentially harmful.

As the WHO points out, these findings “were considered by … its expert panel when developing the current guidelines and are fully reflected in the recommendations.”

Treat mild cases like ordinary seasonal flu

The advice, for clinicians and parents, is to give healthy children with swine flu, who are older than five paracetamol, as well as plenty of rest and fluids–just like for seasonal flu.

Be alert for worsening

However, as the vast majority of severe cases of swine flu develop in previously healthy individuals, it is important to monitor the child for signs of worsening, so that Tamiflu can be administered promptly.

“In children,” the WHO says, “danger signs include

• fast or difficult breathing;
• lack of alertness;
• difficulty in waking up; and
• little or no desire to play.”

Any of these signs may indicate that the child is progressing towards a more severe form of swine flu and needs hospital care. Call the doctor right away, as deterioration may occur very rapidly.

Know the side effects of Tamiflu

For children who need Tamiflu treatment, consider that some may experience side effects other than vomiting. Two studies conducted in England by researchers of the Health Protection Agency (HPA) found that more than 50 percent of a group of children aged 11 to 12, who were given Tamiflu had side effects, such as nausea, headache and stomach pains. Diarrhea and problems sleeping were also reported as well as poor concentration and nightmares.

References

Shun-Shin M., Thompson M., Heneghan C., Perera R., Harnden A. “Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomized controlled trials,” British Medical Journal, August 10, 2009, 339:b3172. doi: 10.1136/bmj.b3172

World Health Organization (WHO). WHO guidelines for the pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. August 20, 2009. [Accessed 23.08.09].

World Health Organization (WHO). Recommended use of antivirals. Pandemic (H1N1) 2009. Briefing note 8. August 21, 2009. http://www.who.int/csr/disease/swineflu/notes/h1n1_use_antivirals_20090820/en/index.html. [Accessed 23.08.09].

By Lorena Tonarelli, MSc