Reports of localized supply issues with Tamiflu have left some providers wondering how to best prioritize who gets the antiviral during a rough flu season.
With the influenza season continuing to show high levels of activity and the recent holidays likely leading to an uptick in flu cases, there has been increased demand for oseltamivir (Tamiflu). The FDA has reported no shortage of the drug, but there have been anecdotal reports of shortages in areas where activity has been high. To address this concern, the Centers for Disease Control and Prevention has released interim guidance for how to prioritize oseltamivir when supply is limited.1
For hospitalized patients, oseltamivir treatment should be prioritized as soon as possible, as it is the only antiviral that is recommended for patients who require hospitalization. It should be started in suspected cases before results have confirmed the patient has influenza, due to the antiviral’s increased efficacy with early initiation. There has been little research into the efficacy of other antivirals such as inhaled zanamivir, intravenous peramivir, or baloxavir in hospitalized patients.
In the outpatient setting, antiviral therapy should be prioritized for patients at increased risk of complications from the flu and who have tested positive within 2 days of onset of symptoms; patients with progressive or severe disease who do not require hospitalization even when confirmation is more than 2 days after symptom onset; and patients who are either pregnant, very recently pregnant, or immunocompromised. Baloxavir is not recommended for any of these groups due to lack of data on safety, efficacy, and duration of treatment. It should also be prioritized for pediatric patients aged younger than 5 years. If oseltamivir suspension is not available, clinicians should request a compounded version from capsules from pharmacists.
Once oseltamivir supply issues have been resolved in the area, providers should go back to the general recommendations for antivirals. The guidance also emphasized that providers should depend on clinical judgment and data when considering antibiotics for patients who come to them with an acute respiratory illness.
1. Interim Guidance for Clinicians to Prioritize Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir. Guidance. Centers for Disease Control and Prevention. December 14, 2022. Accessed January 4, 2023. https://emergency.cdc.gov/han/2022/han00482.asp