This guidance updates and replaces NICE technology appraisal 58 (published in February 2003).

NICE has said that its recommendations about oseltamivir and zanamivir should not reduce efforts to give vaccination (also called the flu jab) to people for whom it is recommended in national guidelines.

The guidance does not cover widespread epidemics.

Oseltamivir and zanamivir are recommended as possible treatments for people with flu if all of the following apply:

  • the person is in an 'at-risk' group
  • the person has a 'flu-like illness' (see page 3) and can start treatment within 48 hours (36 hours for zanamivir treatment in children) of the first sign of symptoms.
  • the flu virus is known to be going around and it is likely that a flulike illness has been caused by the flu virus.

Healthcare professionals should discuss the choice of oseltamivir or zanamivir with the person being offered the drugs. The decision should take into account which drug the person would prefer and any possible unwanted effects. If all else is equal, the cheapest drug should be used.

If there is an outbreak of 'flu-like illness' in a long-term residential or nursing home, oseltamivir and zanamivir may be offered to treat residents in 'at-risk' groups who have symptoms of flu. This could happen even if the flu virus is not around in the wider community outside the home, but the healthcare team should be sure that the illness is flu.

Amantadine is not recommended to treat people with flu.

Your responsibility

The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.

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