When it comes to the flu, antivirals far more effective than antibiotics

Oct 2 2006

It seems that even though influenza has been shown to be better treated with anti-viral medication doctors and hospitals continue to use antibiotics, often with deadly consequences.

New research has shown that anti-viral medication can be life-saving but patients sick with influenza during the influenza season are far more likely to be prescribed antibiotics than antiviral medication.

In two new studies the use of the antiviral medication oseltamivir (Tamiflu), was seen to reduce mortality among patients by 71 percent and significantly reduced hospitalization and complications among young children.

Allison McGeer, a consultant in infectious diseases at Mt. Sinai Hospital, Toronto, says in some cases the failure to provide antiviral treatment may have been fatal.

McGeer and colleagues in the Toronto Invasive Bacterial Diseases Network, selected patients who were taken to hospitals for emergency treatment of symptoms due to influenza.

Many of the patients had been initially treated by their doctor and many of those patients were prescribed medication.

Of the 185 children in the study under age 15, primary care physicians prescribed antibiotics, normally used for treating bacterial infections, in about 24 percent of the cases.

When the children reached the hospital, they were prescribed antibiotics 75 percent of the time; none were administered antivirals.

In the group ages 15 to 64, antibiotics were prescribed 23 percent of the time at the doctors' offices and were prescribed 84 percent of the time at the hospital, although 24 percent were prescribed Tamiflu as well.

For the older patients, 23 percent were offered antibiotics at the doctors' office, 91 percent were given antibiotics at the hospital, although 34 percent were also prescribed Tamiflu.

There were 25 deaths in the study, 22 among persons over age 65, most occurring in the people who were not treated with Tamiflu.

McGeer says she is at a loss as to why doctors fail to get the message that influenza is a virus and antivirals work on viruses whereas antibiotics do not.

Experts say the problem is not confined to Canada but is possibly worse than that in the U.S.

It appears that part of the problem lies with the lack of rapid testing facilities in most pediatric offices and also that there are so many febrile illnesses in children that it is often hard to tell if an illness is influenza.

But another study by drug company Roche that reviewed treatment for more than 15,000 children, has also found that treating children with Tamiflu appears to prevent them from needing hospitalization and reduces the risk of pneumonia and other complications.

Researchers found that children receiving Tamiflu achieved a 91 percent reduction in hospitalization due to respiratory illness, a 50 percent reduction in the overall risk of hospitalization, a 53 percent reduction in the risk of pneumonia, a 39 percent reduction in the risk of ear infections and a 28 percent reduction in the risk of respiratory illness.

According to the Centers for Disease Control and Prevention, influenza kills 22,000 to 36,000 people a year during a 'normal' flu season and up to 200,000 end up in the hospital, but McGeer says that doctors still don't seem to take influenza seriously.

Tamiflu is made by drug company Roche and many countries are stocking up on Tamiflu because of the risk of H5N1 avian flu.

Tamiflu is now routinely given to bird flu victims and doctors say if given quickly enough, it appears to save lives.

The studies were presented at the Interscience Congress on Antimicrobial Agents and Chemotherapy in San Francisco.