Tuesday, September 22, 2020

Usual Care +/- Oseltamivir

R.E.B.E.L.EM - By Salim Rezaie - September 21, 2020
Paper: Butler CC et al. Oseltamivir Plus Usual Care Versus Usual Care for Influenza-Like Illness in Primary Care: An Open-Label, Pragmatic Randomised Controlled Trial. Lancet 2020. PMID: 31839279
"Clinical Question: Does adding antiviral treatment to usual primary care for patients with influenza-like illness reduce the time to recovery?
Author Conclusion: “Primary care patients with influenza-like illness treated with oseltamivir recovered one day sooner on average than those managed by usual care alone. Older, sicker patients with comorbidities and longer previous symptom duration recovered 2 – 3 days sooner.”
Clinical Take Home Point: This study should not change practice. In a non-blinded study with a subjective outcome, we would expect patients who are getting the “fancy pill” to feel better faster. Additionally…
  • Oseltamivir works on neuraminidase. This enzyme is not found on other viruses, and there is no biological mechanism for it to have an effect in these patients
  • Objective outcomes of hospitalization and x-ray confirmed pneumonia showed no benefit with oseltamivir
  • There is an increase in nausea/vomiting in the patients taking oseltamivir"