Wednesday, 13 May 2009

US lack of use of Tamilflu is creating drug-resistance and deaths

If you use Tamilflu too late or in insuficient quantity for it to be
effective, it will create a situation where the virus will adapt
quickly simply because there are too many of the virus still

Whatever virus remaining in a recovering patient will be so minimal as
to reduce the chance for the virus to mutate into a drug-resistance

I don't know the details in the US H1N1 deaths but in both cases,
spine flu was only detected too late. Although there was mention of
treatment with antivirals, it was not stated the type of the antiviral
administered. A/H1N1 is resistant to older antivirals but H1N1 is
resistant to Tamilflu but not Relenza.

In order for WHO to make sure that there is little chance for A/H1N1
to be reistant to Tamilflu, it should give a guideline forbidding
Tamilflu and Relenza use if A/H1N1 were detected 2 days after the
onset of flu symptons, despite knowing for certain that it will mean
the death of the patient.

So, in order to reduce deaths, Tamilflu should be administered as soon
as Swine flu is suspected based on circumstancial evidence. If it
turned out that the flu is resistant to Tamilflu, it clearly shows
that it is the non-fatal usual form of H1N1. There won't be any death
occurring at all unless the patient is very young or old.

I have not read any report on the effectiveness of antiviral when used
on the very young and old. I presume that based on the high fatality,
36000 in USA alone, that antivirals are useless for these groups of
people so using Tamilflu or Relenza should be useless against A/H1N1
as well. Using antiviral for them will only accelerate the mutation of
antiviral-resistant A/H1N1.

The appearance of Tamilflu-resistant A/H1N1 is inevitable but the
question is how many lives will be lost if they are not used while
they are still effective. Will you want to bet your life for a yet
unproven chance that it will delay the mutation of Tamilflu-resistant

Preventive use of Tamilflu should be discouraged unless it is for
people that are exposed to many people such as those in the military,
as had been done by the US navy. The best and cheapest alternative is
just to quarantine probables, either in their own houses, or in
government provided accommodations or hospitals.

Governments must be strong and concerned by legislating and paying for
the loss of income as a result of the quarantine. Restricting the use
of Tamilflu is much worse than quarantine because it will mean the
loss of lives.

WHO: Europe uses more drugs against swine flu

By ELIANE ENGELER – 1 hour ago

GENEVA (AP) — Europe's heavy use of antiviral medication against swine
flu does not appear to be creating drug resistance but countries
should follow the lead of Mexico and the United States and target the
medicine to patients most at risk, the World Health Organization said

The swine flu virus has sickened some 5,251 people in 30 countries,
with 61 people dead, according to WHO figures.

WHO flu expert Dr. Nikki Shindo told reporters there is always a risk
that drug-resistant viruses will emerge.

"European countries, which are mainly importing the cases, have been
using antivirals very aggressively," she said. "Countries like Mexico
and the United States, they are trying to save the treatment for
patients with underlying conditions and also the other groups at
increased risk, such as pregnant women."

Because all of Europe's swine flu cases have links to North America,
European officials may be trying to contain the virus before it
spreads more widely by using antivirals whenever possible. In the U.S.
and Mexico, however, the virus is already widespread, making
containing the outbreak impossible.

It is up to a nation's health experts to decide if infected people
should immediately be treated with antivirals, she said, adding that
past flu experience has shown that "the emergence of these antiviral-
resistant viruses are not directly related to (a country's) usage of

She noted that in Japan, where the per capita use of antivirals is the
highest in the world, there was a very low percentage of antiviral
resistance during seasonal flu outbreaks. And she said drug-resistant
viruses "were first reported from Norway, where normally doctors don't
prescribe antivirals."

With the virus continuing to spread, Swiss pharmaceuticals company
Roche Holding AG said it is donating enough Tamiflu to WHO to treat
5.65 million people. Tamiflu is one of two anti-viral drugs known to
be effective against swine flu if given early enough, the other being
Relenza made by GlaxoSmithKline.

Roche's new donation will replenish a stockpile of 5 million
treatments given to WHO by the drugmaker in 2005 and 2006. The agency
shipped about half of those supplies to poor countries after the
appearance of a new type of swine flu, dubbed A(H1N1). A further
650,000 packets containing smaller doses of the drug will be used to
create a new stockpile for children.

With most cases of the so-called A (H1N1) virus being mild so far,
most patients do not need hospitalization or antiviral therapy, Shindo

But people who already suffer from a weak immune system, diabetes,
cardiovascular diseases or other medical issues such as pregnancy
might be protected by antivirals from contracting a severe form of the
illness or dying, she said.

Associated Press writer Alexander G. Higgins contributed to this

Copyright © 2009 The Associated Press. All rights reserved.

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