WHO: Give at-risk groups anti-flu drugs early

I just got a patient in the ER from a nursing home. She was on Tamiflu. She did not have any flu symptoms. She had been started on Tamiflu because another resident tested positive, and a doc put the whole facility on Tamiflu.

How's that for use of resources?

EDUCATION.....someone needs to educate the doctor who is prescribing Tamiflu as a prophylaxis. No wonder some of the antiviral meds aren't effective in fighting some of the influenza strains and the drug companies have had to develop the IV antiviral Peramivir. I can see giving antiviral meds to someone who has symptoms but not to the entire nursing home!! Someone might want to call the state medical board and inform them on this.

Around here they are only giving Tamiflu if someone is ill enough to be admitted to the hospital.

How ridiculous! So the second my kid starts with a runny nose I'm suppose to give meds? We don't even take meds when we are sick, so no way. Ugh!

I will say that in the case of pregnant women, they should always be given Tamiflu even if they don't appear very sick because H1N1 infection is so riskly for them, and many of the dead weren't presenting with terrible s/s initially. If a pregnant woman can tolerate the drug, it is better to give it. (Some can't because of n/v, and in that case they should give Relenza.)

A doctor who spoke at the recent CIDRAP conference in Minneapolis, said that Brazilians were losing many pregnant women to this virus until they decided to give every pregnant woman a script for the drug (even before they were infected) with instructions to take it if they became ill. The death rate promptly dropped. Another mitigation strategy that worked in lowering the death rates of pregnant women was used in Argentina. They simply told pregnant women not to work and paid them to stay home, but we aren't doing this here. At least there is more awareness of the impending threat to the health of these women by ER and OB docs, and we hope that they will promptly prescribe Tamiflu if the patient presents in the ER although it is likely that an OB consult will result first. And now there is a vaccine...

For the nonpregnant cases in my area that I know of, some were given Tamiflu right away even without testing. There seems to be no strict protocol. It is a difficult problem. That Tamiflu resistance is likely to occur seems inevitable. Resistance is not simply tied to giving out the drug too often with infected swine flu patients, however. Tamiflu resistant swine flu was found very early in this pandemic even without the patient getting any Tamiflu probably because resistant strains of the virus already exist. The question is, how did that happen?

We have the precedent of what has already happened with seasonal H1N1Tamiflu resistance occurring in countries where Tamiflu was not routinely prescribed such as in Norway. Within a year of those cases, virtually all seasonal H1N1 became resistant. Many scientists seemed surprised. It remains a puzzle. You would have expected this to happen first in Japan, a country where Tamiflu has been used all along rather than the northern European countries.

Co-infection by a human host of more than one type of influenza is the likely
culprit. This can occur anywhere in the world where Tamiflu is in use, and quickly
appear in countries continents away. This is different from giving a prophylactic
dose to someone in a family at risk from an infected family member, and then
having them develop a resistant case of flu. Prophylactic Tamiflu is not a good
idea as in that nursing home mentioned in earlier in this thread. Elderly patients
are not as much as risk as the far younger staff are, and staff vaccination is what
should be happening there though it will take time for antibodies to develop.

Dr. Niman of Recominomics speculates that with the continuous wide spread use of massive amounts of Tamiflu in the countries where H5N1, bird flu is still being fought, this may have contributed to the seasonal H1N1 becoming resistant. If someone in a village in Indonesia becomes infected, and the poultry is sickened, the whole village is treated with Tamiflu, the so called "Tamiflu Blanket" being applied. This practice of course, may also contribute to the problem of Tamiflu resistance in bird flu as well, and it has happened on occasion in Egypt and other places.

This remains only a theory of the way of how seasonal H1N1 strains quickly developed the antiviral resistance, but very possibly valid, imo. Co-infection with seasonal H1N1 and novel H1N1, may lead to Tamiflu resistance as well. Apparently there are many routes to this looming problem.

See post #27:

http://allnurses.com/general-nursing...ml#post2635547

Of course, that is not at all what is being said in this thread.

We are all certainly entitled to our opinions, and beliefs about the use of Tamiflu as well as vaccines. But, just for the record, the influenza vaccines used in swine flu vax as
well as the seasonal vax are grown in eggs.

I agree with your statement about pregnant women, Indigo. Most of the pregnant women we've seen have H1N1 do fine, but in this area nearly 100% of pregnant women who have been sick enough with it to be admitted to ICU have died. Think it is a pretty safe idea to start them on Tamiflu/Relenza as soon as they show symptoms since it's hard to tell who will get how sick.

I believe that's what the article is saying and that's what I was commenting on. I really don't know the relevance regarding the ingredients to this particular discussion, but to be more specific the seasonal flu vaccine is grown in fertilized chick embryos and chick kidney cells. Not sure about the swine flu vaccine, I've looked on the CDC site and can't find that ingredient list. Where did you find that info?

How many pregnant have you had admitted?