re: Does tamiflu work as a preventative?

I'm very aware- it's why I specifically mentioned it. The patient in this thread got prophylactic dosing for the household members covered under insurance.

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shite is still expensive, and for a whole family that's probably between $100-200 depending on the insurance....

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And keeping the cost down on the insurance side, specifically by refusing to test for influenza, was a cost-saving mechanism given her clinical judgment that I made specific mention to earlier. You're preaching to the choir. But a whole family's prophylactic dose is probably cheaper than a second trip to the ED with the same or another child, and they're already being treated- a deterrent to re-presenting.

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know what else works as a prophylactic for influenza transmission? washing your fricking hands and using Lysol on surfaces shared with those with the flu... total cost around $15

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No one argues this. But I'm willing to bet adding tamiflu is more effective. I don't have data to prove me right. You don't have data to prove me wrong.

Also, quinolones are more expensive than a long-sleeved shirt, but they do a hell of a job at keeping malaria away in people traveling to endemic areas. There's nothing wrong with prophylaxis in the right clinical setting. That setting being a sick contact in the household on the one day of the year that essentially every clinic and nearly every pharmacy is closed followed by the vast majority of clinics being shut down for the following 3 days is a pretty damn good reason to give a moderately expensive drug to a patient who can afford it.

(no message)

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as a preventative?

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As a prophylactic. And yes.

ETA: i rescind my "lack of evidence" statement and point out that kids with sick siblings are better protected by taking Tamiflu than not. Burden of cost is specifically mentioned. As I said, this is case by case. In this case, I have clinical indication, a willing payer, and the appropriate group to match the study linked.

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nope... just tons of disappointed, pissed off patients that shell out good money for something that didn't do squat for them...

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Good old anecdotal evidence. Patients call the pharmacist when they're pissed about getting sick when they're on a med like that. When the ones that didn't get sick follow up in clinic, they rave about how awesome it is. And the sick ones come back and bitch about "that medicine not working for me." All of it's purely anecdotal, but I feel like the target audience is pretty different. And there's plenty of anecdotal evidence on both sides in my experience. Go check out the Tamiflu thread from a few days ago where a guy didn't fill the script because his doc was unsure and the pharmacist said it was stupid. I think 8 or so different parents who gave it to there kid came in and called it a wonder drug (clarification: this is not the experience I am alluding to, but merely the only evidence I have in a presentable manner)

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ahh... but keep in mind, affordability is subjective.... what's "cheap" to one may be a shite ton expensive to another...

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Totally aware. I frequently talk about the cost of health care and find regimens of inferior quality based on pricing.

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i level with my patients, and tell them that the shite, if taken within the desired time frame will probably take about a day, day and a half off the back end of the flu,

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For someone who bitches about effectiveness, you should try quoting the actual number, which is approximately one half to one whole day.

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if that's worth $100 to the patient, then so be it... i just don't see the benefit vs. the cost, but hey, whatever...

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I very rarely recommend the med. It's case specific. Cost and relatively mild effectiveness to low-risk of complication outpatients are very heavily weighed. And situations look a lot different in an exam room than in a pharmacy.

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promise....

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Check it. Link above is a trial about cost effectiveness with citations of several Post Exposed Prophylaxis trials showing safety and efficacy as a prophylactic.

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you may wanna check that, doc...

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1.5 days is the extreme. 1 day is the median. 12 hours was the original studies' finding.




And I'd love to sit down and have a beer and talk about how screwed up it is because practitioners don't talk to pharmacists, and doctors don't talk to other doctors. I've been through a hospital where, when a subspecialty team was consulted on a patient, a unit clerk who didn't even know the patient's name would call in the consult. Lack of communication is absolutely killing medicine right now, all the way down to the cost. And EHR isn't to blame, but damn it isn't helping.

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Merry Christmas to you and your loved ones.... hope Santa brings you some preventative Tamiflu!

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Merry Christmas to you, too. And, I said it earlier, I wouldn't pay current market price for it myself or even for a prophylactic med in a low-risk (such as a 4 year old, the whole point of discussion) family member, but if it were cheap or free for me, I wouldn't hold it. On some level, it's hypocritical to the miserly side of me, but it's also a testament of the "there's no real reason not to do it." Again, that's the day before Christmas scenario. If this is mid-January, i probably wouldn't give it to any family members.

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hope everyone has a flu free rest of the season

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not likely....

and Merry Christmas

I don't put much stock in the medicine, but big pharma has this country believing that there's a pill for everything. And there's no educating most people on this.
Now I will prescribe Tamiflu for people in the extremes of age and immunocompromised patients.
The current recommendations for prophylaxis is to not give it unless they are symptomatic.

And those calling ER docs idiots or dumbasses need to take a look in the mirror to see who the real dumbass is...

I am exposed to it every day at work. I do not get vaccinated and I have yet to get it. I just wash my hands and stethoscope after every encounter.
I'm not saying that Tamifu doesn't work, but I also feel that the placebo effect comes into play here as well.