Tom Nolan: Is Tamiflu useful in children or not?

Why did the operator at the National Pandemic Flu Service give the child Tamiflu? The cynics will say because the algorithm told him to, but the real answer, according to the UK government, is that it’s the safest thing to do to prevent severe infections. New research in the BMJ questions that policy and looks likely to cause confusion among the public and doctors alike.

The research was a systematic review and meta-analysis of data from four randomised control trials of children under 12 years of age treated with neuraminidase inhibitors for suspected or confirmed seasonal flu.  Antivirals reduce the time to resolution of symptoms or returning to normal activity by 0.5-1.5 days. However, there was no reduction in asthma exacerbations or need for antibiotics.

The media have picked up on these negative findings: we’ve seen headlines such as “Flu drugs ‘unhelpful’ in children” (BBC) and  “No Tamiflu for children, doctors told”  (The Independent). Meanwhile the RCGP and RCPCH have both said that they continue to support the government policy on swine flu.

Tamiflu is not without its side effects – the research reported a number needed to harm of 20 for vomiting. A parent described their child’s experience of taking tamiflu to the BBC:

“I gave my 17-month-old daughter Tamiflu. She was violently sick to the point that she didn’t eat or drink for a whole day and subsequently was taken to hospital. She also slept very badly afterwards for the remaining week, frequently waking up screaming as if having a nightmare. My advice to other parents is to not bother and stick to paracetamol and Ibuprofen suspension….”

Is it time to rethink the guidelines for tamiflu? Or does this research only serve to confuse people more?

GPs fail their MCQs

If you missed last week’s GP newspaper you might still have seen the results of their survey of doctors in the national papers.

“A survey of 251 family doctors, published today, shows that 90 per cent believe that other diseases risk going undetected because their symptoms are similar to those caused by swine flu” wrote The Times.

This might sound like a good statistic to the newspapers but all it really means is that 10% of doctors still don’t know the golden rule for answering multiple choice questions (MCQs): if the question asks you if something is always or never the case the answer is false. The question, as phrased in The Times, is “do other diseases risk going undetected because their symptoms are similar to those caused by swine flu?” It’s really asking “if someone has symptoms similar to swine flu could it actually be something else?” Of course it could.

The survey does highlight the issue of missed diagnosis:

One GP reported seeing a case of measles that had been diagnosed over the phone as swine flu, while another said that he had seen two patients with severe tonsillitis and one with a knee infection who had been prescribed tamiflu.

Asked the question, “Does diagnosing swine flu over the phone mean other diseases may be missed?”, another responded: “Without question. The symptoms are so vague and wideranging, swine flu can masquerade as a vast array of other diseases.”

However, what other steps should be taken to prevent other diseases, such as meningitis, being missed?

Tom Nolan is a GP trainee, London.