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My son has the swine flu. Should I give him tamiflu?
October 25, 2009 7:42 AM   Subscribe

My son has the swine flu. Now what? Should I give him Tamiflu? He is 5 years old, and I also have a 3 year old and a 1 year old, should they also get Tamiflu? Should my wife and I also take it?

My son tested positive for influenza a yesterday, and because of his symptoms and two kids in his class were confirmed for H1N1, the doctor is pretty sure he has the swine flu. So far he is doing ok - he has a fever that is controlled by motrin and tylenol. The rest of the family is doing fine as well. His doctor doesn't think its necessary to take Tamiflu, as she feels its been overprescribed and if his condition does worsen (or if ours do) then we won't have an option as far as medicine is concerned. We talked with another doctor who suggested we do give him TamiFlu and that we all take it ourselves.

Also we talked with a family friend whose son had the h1n1 and they gave their son Tamiflu after he was initially diagnosed. His condition improved after two days, but then it drastically got worse and he had to be taken into the hospital and he almost died, but he pulled through (he was on the news because of his "miracle"). His parents think the TamiFlu made things worse.
posted by tedunni to Health & Fitness (25 answers total) 1 user marked this as a favorite
 
Your doctor said no to the Tamiflu, you have anecdotal evidence that says that using Tamiflu can have unintended effects that are quite serious. The doctor said it's not necessary, so why overmedicate? Wash your hands a lot. More. More. A little more. Good. That's the best way to protect your family.
posted by Geckwoistmeinauto at 7:46 AM on October 25, 2009 [6 favorites]


His parents think the TamiFlu made things worse.

I wouldn't give this an ounce of weight. But getting back to your question, you should follow your doctor's advice because she is in the best position to take into account everything relevant to your son's illness. You can always check in with her again in a day or two, whether or not things have changed, and see what she says.
posted by Inspector.Gadget at 7:49 AM on October 25, 2009 [1 favorite]


He listened to his doctor's advice. She said no. He "talked with another doctor who suggested we do give him TamiFlu and that we all take it ourselves."

So he has conflicting information. To give one doctor more credence just because she had the first treatment suggestion is a bit silly. Second opinions are fine and suggested, but in this case I think you need a third (and I'm not really sure the internet counts).
posted by cjorgensen at 7:54 AM on October 25, 2009 [1 favorite]


If your child is not immunodeficient, and his fever is under control, then I would not add TamiFlu to the mix. Swineflu is not statistically more likely to result in catastrophic illness that regular flu. Treating a child who is ill but stable and in no immediate danger with tamiFlu seems not particularly prudent.

From the CDC:
This flu season, antiviral drugs are being used mainly to treat people who are very sick, such as people who need to be hospitalized, and to treat sick people who are more likely to get serious flu complications. Your health care provider will decide whether antiviral drugs are needed to treat your illness. Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.
[Source]
posted by DarlingBri at 8:00 AM on October 25, 2009 [1 favorite]


I agree that you can't give the parents of the other ill child much credit for their limited experience (perhaps it would have been much worse if he hadn't had the Tamiflu? for example).

As cjorgensen has suggested it might be a case of seeking out a third opinion to help you with this decision.

Also I hope your little guy gets well soon and none of the rest of your family catch it.
posted by gomichild at 8:05 AM on October 25, 2009


If you can, get everyone vaccinated against the swine flu stat. It's almost certain you will all get it now. (It's really not worse than the regular seasonal flu, just has a scary new name.)


Here is the CDC's guide for parents, which basically says talk to your doctor.

More info about what to do if your kid is sick. Seems they don't prescribe Tamiflu unless the kid has an underlying condition.
posted by CunningLinguist at 8:16 AM on October 25, 2009


I'll only speak regarding CDC guidelines.

Here are guidelines for treatment. Your son may or may not fall within those guidelines, depending on whether or not he has a chronic medical illness (e.g. asthma). It is certainly not within guidelines to treat prophylactically, except for certain at-risk populations - your entire household does not require Tamiflu. If your wife is pregnant, if one of your children has asthma or other chronic respiratory illness, or if anyone is immunocompromised, I'd talk to your PCP.

As for preventing the spread of the virus - keep your son in a room away from the other members of your household, everyone should wash their hands frequently and be reminded to refrain from touching their eyes, mouth, and nose. More guidance from the CDC.
posted by archofatlas at 8:16 AM on October 25, 2009


I didn't have an opinion one way or the other on the issue, I just wanted to make it clear the OP had two suggestions by doctors that differed. In the absence of further information, either option seemed valid.

I had a feeling that giving the kid an antiviral didn't seem like the recommended course of treatment, since in a lot of cases they haven't even been recommending people with swine flu even go to the doctor at all, but I'm not a doctor, and these things shouldn't be decided on feelings or what happened to the family friend's kid.

DarlingBri has it, but a third opinion is never bad.
posted by cjorgensen at 8:16 AM on October 25, 2009


Remember, most people with 2009 H1N1 have had mild illness and have not needed medical care or antiviral drugs and the same is true of seasonal flu.

This is something I don't think most people are getting yet. For most people it's fairly mild. And then for a small percentage it's life threatening, with nothing in between. As long as your child's case is in the former class, I see no benefit to his taking Tamiflu. I haven't read anything recent about Tamiflu as preventative for H1N1 so I'll leave that alone.
posted by scalefree at 8:22 AM on October 25, 2009


By the way, to correct any misconception, the vaccine is not being made widely available at the moment to all populations, only those who are particularly at risk.

To quote:
"CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the 2009 H1N1 vaccine when it first becomes available. These target groups include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems."

[Source]
posted by archofatlas at 8:26 AM on October 25, 2009


If you can, get everyone vaccinated against the swine flu stat. It's almost certain you will all get it now.

Getting vaccinated now isn't going to help in terms of catching it from their kid. It takes about two weeks for immunity to develop from vaccination; two weeks from now they'll either have caught it or avoided it.

OP: Taking Tamiflu prophylactically is crazy and whatever doctor told you that should be ashamed. That's how we got into the position we are in with regard to antibiotic resistance, people taking all kinds of antibiotics when they didn't need them. Let's not make the same mistake with antivirals.
posted by Justinian at 8:29 AM on October 25, 2009


My doctor (and my friend's doctor and my friend who IS a doctor and my BIL who is also a doctor) doesn't prescribe Tamiflu unless the person with the flu has underlying health concerns, like asthma. In a normally healthy person, Tamiflu isn't necessarily the best thing. My daughter recently had the H1N1 flu and her fever was controlled by medication. She took lots of fluids and had lots and lots of rest. She recovered just fine. She does not have underlying health concerns.

As a parent, I totally and completely understand the underlying panic you're feeling. My son has asthma (as do I) and thank God he's been vaccinated. With a normally healthy child, I think you just ought to treat this as a regular flu, maybe with a bit more caution than usual. Check on him through the night, keep up with the fever meds even if it means waking him up at 3:00 AM to take them, push the fluids even more, and make sure he's resting.
posted by cooker girl at 8:52 AM on October 25, 2009


Or looking at it another way:

You can seek out as many opinions form medical practitioners, neighbours, and random punters on street corners as you like, but you are still going to be getting nothing more than the opinions of an assortment of people - granted, some will be better informed than others, but they are still just judgement calls.

The guidelines from the Centers for Disease Control and from the World Health Organization, however, say that unless your child is immuno-compromised or has one of the listed underlying conditions like asthma or kidney issues, not to treat with TamiFlu as a matter of course. For my money, that is the highest-level, world-leading consensus you can get, and that is where I would place my faith.
posted by DarlingBri at 8:56 AM on October 25, 2009 [2 favorites]


One more resource from the CDC:

Questions & Answers: Antiviral Drugs, 2009-2010 Flu Season

From the link, boldface mine:
What are the recommendations for the use of antiviral drugs in young children?
The September 22, 2009 updated interim recommendations for the use of antiviral drugs provides additional clarification regarding the increased risk for flu-related complications for young children. Children younger than 2 years old should be considered for early empiric treatment with the antiviral drug oseltamivir if they have suspected or confirmed flu. Hospitalization data available found that children younger than 2 years old were at increased risk for flu-related complications compared to older populations. During April through August 2009, hospitalization rates for lab-confirmed 2009 H1N1 influenza in children younger than 2 years old was 2.5 times higher than the rates for children 2 years to 4 years old. In studies of seasonal influenza, the risk for hospitalization is also highest for infants, with the risk decreasing as a child gets older.


Given this increased risk for hospitalizations, children younger than 2 years are generally recommended for antiviral treatment. Children ages 2 years to 4 years old without high risk conditions and who are not severely ill do not necessarily need antiviral treatment. While children 2 years to 4 years old are more likely to require hospitalizations or urgent medical care for influenza compared with older children, this risk is much lower than the risk for children younger than 2 years old. Providers should use clinical judgment to guide treatment decisions for healthy children.
IANAD, but I would not give the TamiFlu to the 5-year old unless his situation worsens. If the 1-year old comes down with symptoms, I would administer. I would not give it to everyone as a preventative measure.

Echoing other recommendations about keeping in frequent contact with your doctor.
posted by Remy at 8:58 AM on October 25, 2009


I came down with H1N1 in early September, and when I went to the doctor (I work in a kindergarten/preschool, so anytime somebody has a high fever they are required to get it checked out at the clinic) I was prescribed Tamiflu because I have asthma.


The flu itself wasn't that bad, but the Tamiflu ended up making me feel headachey, dizzy, and nauseated every time I took it. But once you start on it, you're stuck until you finish the whole run. So even after the worst of the flu was over, I had to keep taking medicine that made me puke three times a day.
posted by emmling at 9:23 AM on October 25, 2009


IANAD, but I am a med student, on my peds rotation, and we are seeing influenza A positive kids (presumptively with H1N1) in clinic every day. Things you should know:

Tamiflu DOES NOT cure H1N1, the way amoxicillin cures an ear infection. It does not kill virus- it works by limiting viral replication, meaning that it is most effective if given in the first 36-48 hours of infection. If you took your child to the doctor after he had already had symptoms for 2 days, the virus has already had plenty of time to reproduce itself and disseminate throughout the body, and Tamiflu isn't going to do much. (Nor is it preventative- do not take it if you're not sick!)

Also, as many others are saying, the treatment for H1N1, like seasonal flu, is generally supportive and symptomatic, aimed at keeping your kid comfortable. When people die from complications of swine flu, one of the major ones is respiratory distress. That's why they treat kids with asthma more aggressively. Most likely, your child is going to pull through this just fine, so please try to remain calm. It's hard when your kids look sick as a dog, but this is not a doomsday illness, just a newer, more virulent strain of an existing one.

I hope your son recovers quickly and the rest of the family remains healthy!
posted by alygator at 9:51 AM on October 25, 2009 [4 favorites]


All things (in your question) considered, if it were my kids I'd be pleased to have a doctor who is erring on the side of no meds, but has also stated they're doing it to keep those meds in reserve as a treatment option (rather than just being opposed to using it at all.)
posted by davejay at 10:03 AM on October 25, 2009 [1 favorite]


Also we talked with a family friend whose son had the h1n1 and they gave their son Tamiflu after he was initially diagnosed. His condition improved after two days, but then it drastically got worse

Can't speak to the miracle basis....but with the swine flu you get better...and then proceed to get worse for awhile.
posted by filmgeek at 10:33 AM on October 25, 2009


For most people it's fairly mild. And then for a small percentage it's life threatening, with nothing in between.

Just FYI, I'm pretty sure I had it (didn't get tested, so take this with a grain of salt, but I had the gastrointestinal issues with sneezing and coughing and aches and whatnot), and it was pretty miserable. I didn't get the fever (about 20% of cases apparently don't present with fever) so I never felt in any real danger, but I was in bed for five days and the fatigue still lingers. Just making the point that there is indeed an "in between."
Interesting filmgeek - I did indeed feel better three days into it, and even went to work, but then felt worse. I didn't realize that was part of the pattern.
posted by CunningLinguist at 10:54 AM on October 25, 2009


I think scalefree meant that its not necessarily all that severe for a flu, which is true. But the regular seasonal flu is pretty dang awful; a lot of people think they have the flu when they just have a bad cold, but a regular seasonal flu knocks you an your butt for days and days. Being in bed for five days is typical.

Influenza is serious. Swine flu is even more serious not because it's particularly severe but because we don't have immunity to it so everyone can catch it very easily.

My last seasonal flu I had a 104 fever, major body aches, sneezing, coughing, and some disgusting gastrointestinal issues. It was terrible. And I didn't take Tamiflu. There's absolutely no reason to take Tamiflu except under fairly specific circumstances which don't seem to apply here.
posted by Justinian at 12:39 PM on October 25, 2009


What alygator said above. IANAD but my kid (boy, age 15) started getting flu-like symptoms last Wednesday night (103.5 fever, coughing, runny nose, headache, came on suddenly) and as I was concerned about the reported virulence of H1N1, I took him to see our doctor on Thursday. Our doctor, an extremely knowledgeable man, said a few relevant things. 1) if you go to the doctor outside a window of about 40 hours with flu-like symptoms, Tamiflu won't help because there is too much of the virus already in your system for it to work. As Alygator said above, Tamiflu works by stopping the reproduction of the virus. 2) there is no fast test for H1N1, the kind of fast that would make any difference for a doctor deciding treatment (2 hours) so there was no way to definitively diagnose it as H1N1 or seasonal flu. Based on the symptoms, he diagnosed flu and based on the reported incidence in our area, he guessed it was H1N1. 3) taking Tamiflu decreases the duration of the flu, it doesn't cure it, to about 5 days instead of a usual course of 12 days 4) because of 2 and 3, there is no use taking Tamiflu prior to any diagnosis.

Happy ending - after about 24 hours on the Tamiflu, he was a LOT better. As of Saturday, he had no more fever, only the cough remains.

Another note, my doctor (as I said a very smart man) suggested that my son still get the seasonal and H1N1 vaccination because he couldn't be sure that his guess about the flu strain was accurate.

I hope your child feels better soon!
posted by bluesky43 at 1:03 PM on October 25, 2009


My 4 year old got H1N1 a couple weeks ago. She felt lousy for about a week (fever, pathetic, low appetite, etc.) We treated the fever and gave her good things to eat, but really, wasn't very sick. No one else in the house (me, my husband, her one-year-old sister) got swine flu.

From your description, it doesn't seem like your son is particularly sick either, so probably TamiFlu isn't necessary---especially given what others have said about its efficacy.

(For what it's worth, swine flu is practically epidemic up here in Fairbanks, and they're giving Tamiflu to very few kids, as far as I can tell.)
posted by leahwrenn at 1:24 PM on October 25, 2009


Call the doctor back. Explain your worries. Have a longer discussion about tamiflu.
posted by theora55 at 2:14 PM on October 25, 2009


thank you everyone for your help. We were leaning towards not giving the tamiflu and we did call both doctors again and discussed the pros and cons of treating the entire family with Tamiflu and we've decided not to do it. Just hope everything turns out fine.
posted by tedunni at 6:25 PM on October 25, 2009


Glad you reached a consensus. Another anecdote: My almost 4 year old had the flu this last week, and I was leaning toward giving him TamiFlu under the recommendation of the doctor (although a doctor for my older son the previous week did not recommend it). My wife was hesitant about the treatment, but we went ahead and gave it to him. Didn't settle well with him, and he was vomiting within 2 hours. We stopped the TamiFlu after that first dose, and he rebounded quite well after 3 days. Best of luck!
posted by shinynewnick at 7:33 PM on October 25, 2009


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