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    Resistance to Bird Flu Drug Reported

    Tamiflu May Have Failed to Stop Bird Flu in Vietnamese Children

    The Case Against Stockpiling continued...

    In two recent studies from Japan, 16% and 18% of children with the regular flu were reported to be resistant to Tamiflu.

    The high rate of acquired resistance is believed to be due to the fact that young children in Japan are typically given very low doses of the drug, which may be insufficient for getting rid of the flu virus.

    "Personal stockpiling of [Tamiflu] is likely to lead to the use of insufficient doses or inadequate courses of therapy," Moscona writes. "Shortages during a pandemic would inspire sharing of personal supplies, resulting in inadequate treatment."

    She added that undertreatment is a particular concern with regard to children, since they tend to be more contagious than adults and remain contagious for longer periods.

    "The habit of stopping treatment prematurely when symptoms resolve (a well-established tendency with antibiotic therapy) could also lead to suboptimal treatment of influenza and promote the development of drug resistance," she writes.

    Prescribing on Demand

    It is not clear how much personal stockpiling of the antiviral drug has occurred. A few leading public health groups, including the Infectious Diseases Society of America, have called on doctors to resist patient requests for prescriptions to be used for this purpose.

    But medical ethicist Allan S. Brett, MD, tells WebMD that stronger guidelines are clearly needed from public health officials who have so far been silent on the issue.

    The University of South Carolina professor of medicine says doctors would welcome specific directives from the CDC and state departments of health, just as they welcomed them in the fall of 2004 when there was a shortage of flu vaccine.

    "It seems to me that individual practicing physicians should not be put in the middle of something that obviously has so many public health implications," he says.

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