Complying with new flu guidelines may be impractical and costly

Complying with guidelines for the use of a new drug to prevent flu may be impractical and costly, according to new research published on bmj.com today.

National Institute for Clinical Excellence (NICE) guidelines state that oseltamivir should be given to all vulnerable residents in nursing and residential homes each time a single case of flu-like illness is recognised in a resident or staff member and when flu is known to be circulating in the community.

Although oseltamivir prevents flu in young healthy people, there is little evidence of its effectiveness in elderly care home residents.

Researchers in London analysed the implications of putting these guidelines into practice. They conducted surveillance for flu-like illness in 48 nursing homes from 3 November 2003 to 25 January 2004.

Almost three-quarters (35) of the homes (with a total of 2,004 residents) had at least one case of flu-like illness at some point during the four weeks in which flu activity in the community was at "normal seasonal" levels. All these residents would have been eligible for at least one course of oseltamivir during this period.

If these results applied to all 500,000 residents of nursing and residential homes in England, then at least 360,000 courses of oseltamivir should have been offered last winter. The drug costs £12.73 for an initial seven day course.

The NICE guidelines highlight the potential usefulness of oseltamivir in nursing homes, say the authors. However, the use of a single case of flu-like illness as the threshold for preventive treatment may be impractical and costly.

It might be sensible to reserve the drug for control of outbreaks when flu is microbiologically confirmed or strongly suspected. Further studies are needed to determine the best strategy for flu prevention and control in care homes, they conclude.