NICE guidance - the use of oseltamivir , zanamivir and amantadine for the prophylaxis of influenza
Last edited 10/2019 and last reviewed 10/2023
- summary features of NICE guidance include:
- oseltamivir and zanamivir are recommended, within their marketing
authorisations, for the post-exposure prophylaxis of influenza if all
of the following circumstances apply
- national surveillance schemes have indicated that influenza virus is circulating
- person is in an at-risk group
- people at risk are defined as those who fall into one or
more of the clinical risk groups defined, and updated, each
year by the Chief Medical Officer
- current list includes people with:
- chronic respiratory disease (including asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission)
- chronic heart disease
- chronic renal disease
- chronic liver disease
- chronic neurological disease
- immunosuppression
- diabetes mellitus
- people who are aged 65 years or older are also defined
as at-risk for the purpose of this guidance (1)
- current list includes people with:
- people at risk are defined as those who fall into one or
more of the clinical risk groups defined, and updated, each
year by the Chief Medical Officer
- person has been exposed to an influenza-like illness and is
able to begin prophylaxis within the timescale specified in the
marketing authorisations of the individual drugs (within 36 hours
of contact with an index case for zanamivir and within 48 hours
of contact with an index case for oseltamivir)
- exposure to an influenza-like illness is defined as close
contact with a person in the same household or residential
setting who has had recent symptoms of influenza
- exposure to an influenza-like illness is defined as close
contact with a person in the same household or residential
setting who has had recent symptoms of influenza
- person has not been effectively protected by vaccination
- people who are not effectively protected by vaccination
include:
- those who have not been vaccinated since the previous influenza season
- those for whom vaccination is contraindicated, or in whom it has yet to take effect
- those who have been vaccinated with a vaccine that
is not well matched (according to information from the
Health Protection Agency) to the circulating strain of
influenza virus
- people who are not effectively protected by vaccination
include:
- choice of either oseltamivir or zanamivir ishould be determined by the healthcare professional in consultation with patients and carers. The decision should take into account preferences regarding the delivery of the drug and potential adverse effects and contraindications. If all other considerations are equal, the drug with the lower acquisition cost should be used
- during localised outbreaks of influenza-like illness (outside the periods when national surveillance indicates that influenza virus is circulating generally in the community), oseltamivir and zanamivir may be used for post-exposure prophylaxis in at-risk people living in long-term residential or nursing homes, whether or not they are vaccinated. However, this should be done 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 infection with influenza in the index case or cases
- oseltamivir and zanamivir are not recommended for seasonal prophylaxis of influenza
- amantadine is not recommended for the prophylaxis of influenza
- oseltamivir and zanamivir are recommended, within their marketing
authorisations, for the post-exposure prophylaxis of influenza if all
of the following circumstances apply
For detailed advice then consult the full guidance (1).
Reference: