“If I have the flu, shouldn’t I be taking Tamiflu?” is a question that you will hear over and over in the winter months in your primary care practice. But it’s important not to prescribe Tamiflu willy-nilly because (1) why would you go through 4 years of med school to become a prescribing bot (2) oseltamivir-resistant influenza is not a huge thing, but it has the potential to become one…
So who SHOULD get Tamiflu, and for how long?
Naturally, it depends. Uptodate has a lot of data/learning points that I summarize:
If a patient is exposed to someone with the flu and needs Tamiflu for prophylaxis, they would ideally start it 75 mg BID <48 h after exposure and take it for 7-10 days.
If a patient is diagnosed with flu and you prescribe it for treatment, realize that studies have only shown this medication to reduce symptoms for 1-2 days ONLY if the patient starts taking Tamiflu <48 h of being diagnosed. Evidence for whether Tamiflu reduces hospital stay, severity of symptoms, or mortality is mixed at best. People being treated for flu should have a 5-day course.
That being said, high-risk groups SHOULD be treated:
- Immunocompromised, such as HIV or bone marrow transplant (a 1-2 week course is the longest that a patient should be on; Tamiflu is safe for at least a 6-week course but there’s no studies showing benefit to giving it longer)
- “immunocompromised” patients with severe COPD/asthma, liver disease, renal disease, diabetes, active cancer (basically the same people who would qualify for an early Prevnar)
- Pregnant women
- Nursing home residents
- ANYONE who needs to be hospitalized because of their symptoms