E-DRUG: Lancet: no evidence oseltamavir will be effective in pandemic (2)
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Dear E-druggers,
As we do not currently appear to have a suitable alternative medicine for use in case of a pandemic influenza , at least in the short term, it is very important that we are guided to understand and analyse the message(s) in the article by Jefferson and his colleagues (antivirals for Influenza in healthy adults: systematic review -The Lancet, Jan 19, 2006), especially as, for many of us, this has come to our notice (gratitude to e-drug), at the same time as the Guardian article (Flu drugs 'will not work' if pandemic strikes - The Guardian, January 19).
On the one hand, I get a message that "there is no evidence that oseltamivir will be effective in a pandemic" and, on the other, I seem to get a message that it is use of the drug "without concomitant measures, such as barriers, distance and personal hygiene", which is the problem.
Personally, I find the Lancet article more "precautionary� than "excluding". I also think the article is well written and argued in many aspects. For example, the authors start discussing their findings by reminding us "As for all systematic reviews, our findings and interpretation are limited by the quantity and quality of available evidence�. They also suggest "the use of neuraminidase inhibitors should not be considered without concomitant measures such as barriers, distance and personal hygiene". There are also a number of apparently positive commentary on neuraminidase inhibitors within the article, e.g. "Both neuraminidase inhibitors are effective in preventing all types of complications in the intention-to-treat population...", " neuraminidase inhibitors are not associated with any adverse events when used as treatments as opposed to prophylaxis...."
I will appreciate views on questions currently on my mind which are, "what should we as front line practitioners, involved in procurement and supply for example, conclude from this review finding?", and what message should we pass on to patients/consumers?" After all, it is the final behaviour of patients/consumers, including adherence to treatment, which will make the difference, should there ever be a pandemic. We all hope and pray in the meantime that this doom's day does not materialise.
Best regards,
Murtada M. Sesay
Technical Officer (Pharmaceuticals)
UNICEF Supply Division
Tel: +45 3527 3098
Mobile: +45 28 23 28 07
E-mail: msesay@unicef.org
Web: www.unicef.org/supply