The National Institute for Health and Clinical Excellence (NICE)’s newly-extended guidance covering flu prevention recommends the use of Roche’s Tamiflu (oseltamivir) and GlaxoSmithKline’s Relenza (zanamivir), in certain circumstances.

NICE’s guidance says that Tamiflu and Relenza should be given to people if national surveillance schemes indicate that the flu virus is circulating, and if the person: is in an at-risk group; has been exposed to someone with a flu-like illness and is able to begin preventive treatment within the timescale specified for each drug – within 36 hours of Relenza and within 48 hours for Tamiflu; and has not been effectively protected by vaccination.

During localised outbreaks of flu-like illness, the drugs should be administered to people living in long-term residential or nursing homes who have been in contact with the illness, whether or not they have been vaccinated, but this should be done only if there is a high level of certainty that flu is the causes of the localised outbreak of illness, it adds.

The guidance does not cover the circumstances of a pandemic, an impending pandemic or a widespread epidemic of a new strain of flu to which there is little or no community resistance. It also points out that neither Tamiflu nor Relenza is recommended for general use during the flu season for prevention of the illness, unless the above circumstances apply.

The flu season is fast approaching, and while most people who get it recover within a week or two, some develop more serious problems such as chest infections. People who live in residential accommodation such as care homes, or who are in other health care settings, are at greater risk of infection, commented Dr Gillian Leng, NICE’s deputy chief executive and executive lead for the guidance.

“Vaccination is the main way to prevent flu and the Department of Health currently recommends that people who are at risk of flu infection or complications are vaccinated at the beginning of each winter. Oseltamivir and zanamivir can be used as an additional treatment option as they work in a way that stops the virus from multiplying in the body,” she said.

For the guidance, NICE also examined the use of the much older antiviral amantadine, but declined to recommend its use for flu prevention.

- “At-risk” groups include people aged 65 and older, and all people with: chronic respiratory disease – including asthma that requires continuous or repeated use of inhales or systemic steroids or with previous exacerbations requiring hospital admission; chronic heart disease; chronic renal disease; chronic liver disease; chronic neurological disease; immunosuppression; and diabetes mellitus.