A new study casts doubt over whether all children with swine flu should be given antiviral drugs such as oseltamivir (Tamiflu) or zanamivir (Relenza).
Some governments, including the UK鈥檚, insist that everyone with swine flu should be offered antivirals as part of a 鈥渟afety first鈥� strategy.
But the new study, published in the journal BMJ, suggests the strategy is misguided.
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Small help
It concludes that treating children under 12 with antivirals does very little, shortening the duration of disease by just a day or so, and decreasing by just 8 per cent the likelihood that an infected child will spread it to others.
Also, Tamiflu causes additional vomiting in 5 per cent of children already vomiting because of their illness. Nor does it bring any benefits for asthmatics, as implied by advice from the UK government鈥檚 Health Protection Agency.
鈥淭he results show the effect is fairly small for most children,鈥� says of the University of Oxford, who led the research.
His team鈥檚 advice is for parents to treat mild flu symptoms with the usual medicines for controlling fever, plus plenty of rest and fluids.
Value unknown
Even if complications develop, the value of giving antivirals to children is unknown, the researchers say. 鈥淲hat we need are studies large enough to let us know if antivirals reduce the risks of serious complications such as pneumonia or hospitalisation in children,鈥� Thompson says.
Another bonus of limiting treatment in children is that it will reduce the risk of the virus becoming resistant to the drugs, he says.
Responding, the British government鈥檚 said that the BMJ study is based on seasonal flu and so may not apply to swine flu.
鈥淲hilst there is doubt about how swine flu affects children, we believe a safety-first approach of offering antivirals to everyone remains a sensible and responsible way forward,鈥� said a spokesperson. 鈥淗owever, we will keep this policy under review as we learn more about the virus and its effects.鈥�
Thompson accepts that his review only looked at seasonal flu. 鈥淏ut about two-thirds of the studies were influenza A, which is what the current strain is,鈥� he says. 鈥淪o we would expect our results to be applicable to swine flu.鈥�
Sharp shooting
Thompson says that other countries are deploying a more targeted approach, unlike the scattergun approach in the UK. 鈥淔or example, Canada, Ireland and the US are only recommending antivirals for patients at particularly high risk, or with severe illness,鈥� he says.
鈥淚t may be worth the Department of Health taking the new research on board and perhaps having a more targeted approach to the use of antivirals, or urgently conducting randomised controlled trials of children and adults to identify whether there are subgroups of children who will benefit from antivirals, and whether they do have an impact on severe complications such as pneumonia or hospitalisation,鈥� says Thompson.
鈥淚 hope the evidence from such trials will help parents and family doctors make sensible decisions about which children to treat.鈥�
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