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Tamiflu - The Magic Bullet For Flu

   By: Barbara Camie

Tamiflu is the magic bullet for bird flu, however it may be useful in some specific situations. For example, if you have been in close contact with someone who is infectious or work in a high risk occupation (e.g., health care worker). For current seasonal flu viruses it is quite effective, although whether it will have the same effectiveness for H5N1 is unknown. Some evidence suggests that the current dosage is inadequate for H5N1 and might promote drug resistance. There is still a shortage and if a pandemic occurs soon it almost certainly rationed.

Some essential personnel may also be put on prophylactic dosage. Its use therapeutically is more limited, as it must be given soon after onset of symptoms and even then is not a cure but at best only shortens the duration and reduces severity.

Roche's recommends dosage schedule (75 mg/day prophylactically and 150 mg/day in divided doses for threatment) may need to be doubled for H5N1 and the Vietnamese, who have seen the most cases, are increasing the duration of treatment from five days to seven:

"The virus is multiplying to higher levels than normal human viruses, therefore it may take more drug to control this higher level of virus,'' said Jennifer McKimm-Breschkin, a virologist at Australia's Commonwealth Science and Industrial Research Organization (CSIRO) in Melbourne.

The uncertainties about the efficacy of Tamiflu in human H5N1 are even greater for the H3N8 virus now more prevalent in dogs. Canine influenza is clinically similar to kennel cough (although the vaccine for kennel cough won't protect against influenza, of course). It has about a 5% mortality. Little is known about the pharmacokinetics of the drug in dogs, how long it should be given or whether use in domestic animals might promote viral resistance (although the canine subtype is different than H5N1, so unless there were recombination between N8 and N1 this seems unlikely).

"Some H5N1-infected patients treated with Tamiflu have had resistant virus emerge during the treatment, hence the theory is that higher doses may prevent resistance emerging,'' McKimm- Breschkin said.

Thus assuming the drug will work for this virus, the doubling of recommended dosage essentially cuts the available supply in half. So it is interesting to observe that available supplies are making their way into veterinary practice and being used for dogs.

The same drug has veterinarians buzzing about its use against the newly identified canine influenza and against more threatening diseases such as parvovirus. Vets are offering their findings on their Web sites and swapping Tamiflu anecdotes on the Veterinary Information Network, a members-only site for animal doctors.

Although the prevalence of canine influenza is not yet known, researchers at one university found a 15 percent infection rate among 2,000 symptomatic dogs tested.

Barbara Camie

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