Neuraminidase inhibitors for influenza A and B

Editor—The paragraph for This week in the BMJ accompanying the systematic review and meta-analysis by Cooper et al of the effectiveness of neuraminidase inhibitors for influenza is at odds with the paper's results.¹ It states: “The treatment also lowers the risk complications that require antibiotics by 29-43% when it is given within 48 hours of onset of symptoms.”

Cooper et al state that only one study (WV15670) in otherwise healthy adults reported a non-significant relative reduction (oseltamivir v placebo, 43%) in the odds of complications requiring antibiotics in the intention to treat population and a significant relative reduction (87%) in the flu positive population. Among children, a 35% relative reduction in the odds of complications requiring antibiotics was observed in one study (WV15758). Cooper et al looked at 17 studies in total. They do not comment on the effect on antibiotic requirements in their abstract, presumably because of the limited evidence available.

As a general practitioner I read the paragraph for This week in the BMJ with interest thinking a new and dramatic benefit had emerged, but the evidence for the statement that antibiotic requirements are reduced seems far from compelling on reading the paper. That together with a reduction in duration of symptoms of only half to one day with early treatment still makes me highly sceptical about promoting these costly drugs in a cash strapped NHS.