Sorry list, two postings in the same day
is too much I know. Do these help, Martin?
We’ve trawled the literature for
oseltamivir to produce the best patient decision aids we can. You can access
them via the link from our home page here http://www.npc.co.uk/
…..or directly on our NPCi
e-Learning site here http://www.npci.org.uk/therapeutics/infect/commonintro/patient_decision_aids/patient_decision_aid1.php
It’s not great data but the best we
can find. If you can find better please tell us, but the
In terms of decision making, values
matter. National or regional public health values (driven by onerous
responsibilities to see the health system optimally prepared, no avoidable
catastrophes, disruption to essential services avoided / minimised, and an
excess of flu related deaths at least as low as other developed countries) would
indicate wide use of oseltamivir as being entirely reasonable despite the data
being limited, at least in some patient groups. The trade off is the remoter
risk of future resistance and the cost - but the swine flu is now and the
resistance is a future possibility. Cf clopidogrel in ACS, any antibiotic
prescribing for RTIs and many more examples.
Individuals (patients and clinicians) might make different choices based on their
perspective and values, none of which are likely to be exactly the same as each
others. And we might all make a different choice when we actually have the flu,
or someone we know has had flu-related pneumonia or worse, as opposed to
dispassionate discussions when we don't.
Australian hospital docs on a recent
Both the population and the individual perspectives (and nota bene the plural) seem
to me to be entirely legitimate.
Bw
Neal
From:
Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Brian Alper MD
Sent: 21 September 2009 14:06
To:
[log in to unmask]
Subject: Re: Do the antivirals
reduce mortality in flu?
It depends on what outcome you are promoting the
antivirals for:
If for mortality – there is observational
evidence for seasonal influenza for hospitalized adults
If for duration of illness – there are
randomized trials (seasonal influenza)
If for other complications – there some
randomized trials (seasonal influenza)
If for reducing transmission to others –
I’m not sure of evidence for “treatment” but there is
evidence for prophylaxis
Brian S. Alper, MD, MSPH
Editor-in-Chief, DynaMed (www.ebscohost.com/dynamed)
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]]
On Behalf Of
Sent: Monday, September 21, 2009 8:59 AM
To: [log in to unmask]
Subject: Do the antivirals reduce mortality in flu?
Sorry
Naïve question but I could not find any RCT's - am I
missing something here or are we promoting unproven therapy?
Thanks
Martin
(neuraminidase and influenza and mortality) AND
(randomized controlled trial[Publication Type]