NICE guidance - the use of zanamivir , oseltamivir and amantadine for the treatment of influenza

Last reviewed 10/2023

The NICE guidance is summarised below:

This guidance has been prepared in the expectation that vaccination against influenza is undertaken in accordance with national guidelines. Vaccination is the most effective way of preventing illness from influenza, and the drugs described in this guidance are not a substitute for vaccination. This guidance does not cover the circumstances of a pandemic, impending pandemic or a widespread epidemic of a new strain of influenza to which there is little or no community resistance.

• oseltamivir and zanamivir are recommended, within their marketing authorisations, for the treatment of influenza in adults and children if all the following circumstances apply:
  • national surveillance schemes indicate that influenza virus A or B is circulating
  • the person is in an 'at-risk' group as defined
  • the person presents with an influenza-like illness and can start treatment within 48 hours (or within 36 hours for zanamivir treatment in children) of the onset of symptoms as per licensed indications
• for the purpose of this guidance, people 'at risk' are defined as those who have one of more of the following:
  • chronic respiratory disease (including asthma and chronic obstructive pulmonary disease)
  • chronic heart disease
  • chronic renal disease
  • chronic liver disease
  • chronic neurological conditions
  • diabetes mellitus
  • people who are aged 65 years or older and people who might be immunosuppressed are also defined as 'at-risk' for the purpose of this guidance
• choice of either oseltamivir or zanamivir in the circumstances described should be made after consultation between the healthcare professional, the patient and carers
• during localised outbreaks of influenza-like illness (outside the periods when national surveillance indicates that influenza virus is circulating in the community), oseltamivir and zanamivir may be offered for the treatment of influenza in 'at-risk' people who live in long-term residential or nursing homes. However, these treatments should be offered only if there is a high level of certainty that the causative agent in a localised outbreak is influenza (usually based on virological evidence of influenza infection in the initial case)
• amantadine is not recommended for the treatment of influenza

The NICE guidance does not cover the circumstances of a pandemic or a widespread epidemic of a new strain of influenza to which there is little community resistance.

For more detailed guidance then consult the full technology appraisal (1).

Reference:

1. NICE guidance (February 2009). Guidance on the use of zanamivir, oseltamivir and amantadine for the treatment of influenza.