Healthy people with swine flu should not be given Tamiflu, says WHO

Healthy people who catch swine flu but show only mild symptoms should not be given Tamiflu, the World Health Organisation (WHO) has said.

There have been fears that mass use of Tamiflu will encourage the virus to become resistant to the antiviral.

The advice contradicts British policy on the issue, which has seen hundreds of thousands of doses of the antiviral given to people with the virus.

Today's advice, published on the WHO website, said most patients were experiencing typical flu symptoms and would get better within a week.

It said Tamiflu (also called oseltamivir) and another antiviral Relenza (also called zanamivir) should not be given to healthy people who have only mild symptoms.

However, the drugs should be given quickly to patients in a serious condition or who appear to be deteriorating.

Those in at-risk groups - such as people with an underlying medical condition like diabetes - should also receive the drugs promptly.

The latest WHO advice, from a panel of international experts, comes as new figures show that 45,986 courses of antivirals were given to patients in England in the week ending August 18. In the previous week, 90,363 courses of antivirals were given out.

There have been fears that mass use of Tamiflu will encourage the virus to become resistant to the antiviral.

Researchers have also expressed concern over the side effects of the drug, including sickness, nightmares and insomnia in children.

A team from Oxford University said earlier this month children with mild symptoms should not be given the antiviral to combat swine flu and urged the Department of Health to urgently rethink its policy.

The warning comes after the Government's chief medical officer said yesterday it was "virtually impossible" to accurately predict when a second wave of swine flu will hit the UK.

Sir Liam Donaldson said the Government was expecting the number of cases to rise in the autumn but it was difficult to predict the timing with accuracy.

There are currently 263 patients being treated in hospital in England, of which 30 are in intensive care, down on the 371 (39 in intensive care) reported last week.

The number of deaths linked to the virus stands at 54, with almost half of those (25) having died in London.

A statement from the WHO said the new guidelines ''represent the consensus reached by an international panel of experts who reviewed all available studies on the safety and effectiveness of these drugs.

''Emphasis was placed on the use of oseltamivir and zanamivir to prevent severe illness and deaths, reduce the need for hospitalisation, and reduce the duration of hospital stays.

''Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment.

''Healthy patients with uncomplicated illness need not be treated with antivirals.''

The guidance says serious cases should be treated immediately.

''Evidence reviewed by the panel indicates that oseltamivir, when properly prescribed, can significantly reduce the risk of pneumonia (a leading cause of death for both pandemic and seasonal influenza) and the need for hospitalisation.

''For patients who initially present with severe illness or whose condition begins to deteriorate, WHO recommends treatment with oseltamivir as soon as possible.

''Studies show that early treatment, preferably within 48 hours after symptom onset, is strongly associated with better clinical outcome.

''For patients with severe or deteriorating illness, treatment should be provided even if started later.

''Where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given.''

The guidance goes on to talk about at-risk groups, recommending they also receive the drugs.

''For patients with underlying medical conditions that increase the risk of more severe disease, WHO recommends treatment with either oseltamivir or zanamivir.

''These patients should also receive treatment as soon as possible after symptom onset, without waiting for the results of laboratory tests.

''As pregnant women are included among groups at increased risk, WHO recommends that pregnant women receive antiviral treatment as soon as possible after symptom onset.''

The document notes that an underlying medical condition does not always predict who will be most seriously affected by swine flu.

''Worldwide, around 40% of severe cases are now occurring in previously healthy children and adults, usually under the age of 50 years.

''Some of these patients experience a sudden and very rapid deterioration in their clinical condition, usually on day five or six following the onset of symptoms.

''Clinical deterioration is characterised by primary viral pneumonia, which destroys the lung tissue and does not respond to antibiotics, and the failure of multiple organs, including the heart, kidneys, and liver.

''These patients require management in intensive care units using therapies in addition to antivirals.

''Clinicians, patients and those providing home-based care need to be alert to warning signals that indicate progression to a more severe form of illness, and take urgent action, which should include treatment with oseltamivir.

''In cases of severe or deteriorating illness, clinicians may consider using higher doses of oseltamivir, and for a longer duration, than is normally prescribed.''

Looking at children, the WHO experts recommended ''prompt antiviral treatment for children with severe or deteriorating illness, and those at risk of more severe or complicated illness.''

They went on: ''This recommendation includes all children under the age of five years, as this age group is at increased risk of more severe illness.

''Otherwise healthy children, older than five years, need not be given antiviral treatment unless their illness persists or worsens.''

The WHO guidance says doctors, patients and carers "need to be alert to danger signs that can signal progression to more severe disease."