Here are some questions that require the 2 assumptions below:
1. Tamiflu will have some mitigating affect on human bird flu infection.
2. A 10-capsule treatment is all you have available & that size dosage will
be sufficient to help.

OK, here are the timing questions (please label your replies as to whether
they include some hard info, they are informed guesses or they are just
gut feelings! Heck, I'll take anything I can get!

1. Is it wiser to take Tamiflu preventively when an outbreak occurs locally,
rather than waiting until you or a family member has avian flu?
2. Is it wiser to wait to take Tamiflu as a preventative med until a family
member is ill or you are caring for an ill person, rather than using it
earlier, as in #1?
3. OR, Is it wiser to wait until you actually think you have avian flu before
taking Tamiflu?
4. How long would the preventitive protection (if there is any) last
after taking Tamiflu preventatively?

Lots of suppositions here, I realize. But does anyone have a clue
regarding the most efficient use of a 10-capsule treatment of Tamiflu?

Thanks. Rocky

Rocky, you have to take it within 48 hours of the symptoms first appearing.  The earlier you take it, the better.   If possible, try even take to take it within 24 hours. 

 

Now, if you have more than one packet of Tamiflu, you can also take it during the outbreak as a preventive measure.

 

If you have a limited supply and you have to use it wisely, then save it for when the symptoms first appear – No more than 48 hours after the symptoms first appear.  If you wait longer than 48 hours, it may not be effective.  Again, if you can take it within 24 hours of noticing symptoms, then do it.  

 

My plan: I went and got a regular flu shot so I don’t confuse the BF with the regular flu because the symptoms start off exactly the same.  Because of this, you might end up using it on the regular flu by mistake.  If you get a regular flu shot, then you can most likely rule out the regular flu when the symptoms appear.  This is the exact reason why people should get a flu shot.  It will really help narrow the possibilities of the type of flu somebody might have.    

Edited by Albert

Rocky wrote: Another question...if you get the avian flu and survive, are you then immune to getting it again? Rocky

Yes, you are immune then.
Until..... the virus mutates......

As far as I understand it:
Once the virus goes H2H they expect several 'waves' with a couple of weeks - months in between during which time the virus mutates (again and again).
Usually it becomes less pathogenic but more easily transferrable.
The first wave is the worst (deadliest), after that the virus 'learns' not to kill all it's hosts....

You can compare it to an earthquake with several aftershocks.

If you survive a wave you are then immune for *that particular strain* of the virus, not for others.
That is why they can't make any vaccine right now, they have to wait until the virus has mutated in the H2H-format for a vaccin to work.

If you read about the 1918 flu it happened like this as well.


sorry,
Marjo

The Netherlands

Tamiflu: Please see below article about the timing a dosage.  This was the first (and only one that I know of) that calls into question the dosage of Tamiflu.  The extract points to double dosage for 8 - 10 days, which would mean that you would need 40 caps for a course of treatment.  Since this trial, several experts have weighed in that, YES, it does appear that this dosage level/length may be needed but until we have human cases treated with this regime we will not know for sure.  Please note the abysmal survival of mice on the current recommended dosage level/length.  The article I took to my doc was from the NEJM...I suggest you do a google if you want further information & best available information after you have read this extract.

Prophylactic usage is still recommended at 1 cap a day for length of exposure.

If you are over 50 and Tamiflu is in short supply and you have <50's that you are concerned with, I (ME, PERSONAL OPINION HERE!) might forgo Tamiflu as the chance of the deadly Cytokine storm in >50's is dramatically less than the younger.

Link To Article

Review
MEMPHIS, Tenn., July 18-The anti-influenza drug Tamiflu (oseltamavir) protected mice against a lethal challenge with the avian influenza strain when the drug was given over an extended period, reported investigators here.

Half of the mice that were infected with a highly virulent strain of virus and received the highest dose of Tamiflu for five days survived, as did 80% of the animals who received the same high dose over eight days of treatment.

Whether Tamiflu will offer the same protection in humans infected with the same or a similar variant of the avian flu virus is uncertain, as is the future availability of antiviral drugs in quantities large enough to prevent widespread mortality from a flu pandemic.

A new variant of the H5N1 influenza strain is racing through flocks of poultry in Asia, and has recently been detected in migrating geese. This variant, which has turned up in humans who handled or were in close contact with infected birds, kills about half of all infected people, and there is evidence of person-to-person transmission among members of a family in Thailand, according to Hui-Ling Yen M.D. and colleagues of St. Jude Children's Research Hospital here and the University of Michigan in Ann Arbor.

Their findings are reported in the July 15 online edition of The Journal of Infectious Diseases.

An outbreak of a different antigenic variant of the H5N1 strain in 1997 was stopped by a mass slaughter of poultry in Hong Kong, but variants of the virus continue to circulate in Southern China, the authors noted.

Public health officials have reason to fear that H5N1 could be the Big One, the viral strain that causes a global pandemic similar to the so-called "Spanish Flu" outbreak of 1918-1919, which killed more than half a million Americans and up to 50 million people worldwide, according to the U.S. Centers for Disease Control and Prevention.

In the current study, the investigators gave Tamiflu to mice four hours before injecting them with a virulent form of H5N1 that is currently circulating in Asia (H5N1 A/Vietnam/1203/04, or VN1203/04). Even at 10-fold dilution, the virus was highly pathogenic and lethal to all of a group of five mice injected but not treated with Tamiflu.

Following inoculation with the virus, the pre-treated mice were given additional Tamiflu in doses of either 0.1, 1.0 or 10 mg/kg/day twice daily for either five or eight.

The investigators found that Tamiflu produced a dose-dependent antiviral effect against the VN1203/04 variant.

"The five-day regimen at 10 mg/kg/day protected 50% of mice; deaths in this treatment group were delayed and indicated the replication of residual virus after the completion of treatment," the authors wrote. "Eight-day regimens improved oseltamivir efficacy, and dosages of 1 and 10 mg/kg/day significantly reduced virus titers in organs and provided 60% and 80% survival rates, respectively." Overall, the efficacy of the five- and eight-day regimens differed significantly (death hazard ratio, 2.658; p<0.01).

They note that the VN1203/04 variant is more pathogenic in mice than the variant that caused the 1997 Hong Kong outbreak (A/HK/156/97), and that a prolonged, higher-dose Tamiflu regimen may be necessary to get the desired antiviral effect.

"When the next pandemic hits, antivirals will be our only defense for at least the six to nine months it takes to make a new vaccine," said Walter E. Stamm, M.D., president of the Infectious Diseases Society of America, in a statement issued last month. "But right now, if Asia's bird flu or another strain turns into a pandemic, we'll be caught nearly empty-handed."

The society estimates the Health and Human Services department should have on hand 52 to 84 million courses of antiviral drugs to treat the population at large in an epidemic, and that another 15 to 40 million courses would be necessary to protect health care workers and emergency responders in a crisis.

As of June 2005, HHS had only 2.3 million antiviral courses available at stockpile that is "totally inadequate and unlikely to provide any meaningful benefit to our population," wrote Dr. Stamm in a letter to HHS Secretary Michael Leavitt.

Related articles:

• Government Trial to Test Bird Flu Vaccine

• CDC: Asian Bird Flu May Cause Pandemic

Primary source: The Journal of Infectious Diseases
Source reference:
JID 2005; 192

Additional source: U.S. Centers for Disease Control and Prevention


Additional source: Infectious Diseases Society of America

Gross, but may be necessary. Can we just drink someone elses urine?  That would add a kinky factor that might make it go down easier.

Before you believe Tamiflu is the Silver Bullet, let's see how the people in Turkey make out, the ones in the hospital, They are recieving professional help and recieved the pill on schedule.  If they all live, then perhaps we can put out trust in Tamiflu,  Has the boy in China died, he's been under treatment since the middle of Dec. and he's been getting 2 dr's and 3 nurses taking care of him around the clock.

Google "Tamiflu Rumsfeld"

How ironic its the only thing that can combat birdflu. How much did the US order 1 billion dollars worth.

Trigger, I took the NEJM article to my Doc & showed him the double dose x 8 days, right there in black and white.  He wrote my hubby & I each a scrip for 2 standard courses of treatment.  My insurance only paid for 1 course (because that's the standard) but I didn't care, I would have paid out of my pocket for all of it if I had to.  Son & DL same.  Between everyone's we have enough for a full treatment for Son & DL...hubby and I will just take our chances.

D.

i seach for company produce avian flu vaccines for animals

SZ, I can't understand your recommendation of the DOUBLE DOSE A DAY. In the study they gave three different doses to the mice. .01mg/kg  1mg/kg and 10mg/kg. The 10mg or the highest  dose is equivalent to the human dose recommended daily dose. The only thing this study seems to prove is that you need to extend the time from 5 days, to 8 days. Meaning a total of 16 capsules, not 40. This is also emphasized by the fact that your doctor doubled your dose, by writing you  prescriptions for 2 doses for each of your family members. He didn't quadruple it and write it for 4 doses for each family member. It The standard recommended dose is 2 capsules for 5 days. In mice that produced a 50% mortality rate. The 2 capsules a day for 8 days produces a 20% mortality rate. That is a TOTAL OF 16 CAPSULES. Since the virus is still shed after 8 days, it would make sense to go to 10 days, making it a total of 20 capsules, not 40.  Re-read the article below. I worry that you will needlessly put yourself at jeopardy by giving your two kids a dose of 40 capsules, and leaving none for you and your husband. This could be over medicating your kids, and could possibly leave them orphans for no medical reason. Please don't take my word, please take the study to your doctor and ask him. It seems he understood the dosing recommendation fro the study to be a double dose.  Her is the article below.

.

.

Here it is in plain ENGLISH.....

Study: Oseltamivir helps mice survive H5N1 infection Jul 18, 2005 (CIDRAP News) – Researchers report that the antiviral drug oseltamivir helped mice survive infection with the H5N1 avian influenza virus, boosting hopes that the drug could be an effective weapon if the virus sparked a human flu pandemic. Up to 80% of mice treated with oseltamivir survived the infection, whereas all mice treated with a placebo died, according to a report by a team of leading influenza virus researchers in the Journal of Infectious Diseases. The team also determined that the current strain of the H5N1 virus, which has killed at least 54 people in Southeast Asia in the past 19 months, is much more virulent than the H5N1 strain that killed 6 of 18 people infected in Hong Kong in 1997. The H5N1 virus is regarded as likely to trigger a flu pandemic if it evolves into a form that could pass easily from person to person. If that happens, it will take months to produce a vaccine specific to the virus. In the meantime, oseltamivir (Tamiflu) and similar drugs, called neuraminidase inhibitors, might be the only effective medications for preventing and treating the illness, according to disease experts. Neuraminidase inhibitors block a protein that enables flu viruses to leave host cells. "We need to know whether antiviral drugs can prevent and treat avian flu, because in the early stages of a global outbreak, most people would be unvaccinated," said Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Disease (NIAID), which sponsored the study. Fauci was quoted in an NIAID news release. The NIAID said the study is the first published research on the use of oseltamivir against the H5N1 strain now circulating in Vietnam. It was conducted at St. Jude's Children's Research Hospital in Memphis and authored by Hui-Ling Yen, Arnold S. Monto, Robert G. Webster, and Elena A. Govorkova. The investigators used an H5N1 strain derived from a Vietnamese patient who died. They inoculated 80 mice with the virus and treated them with one of three possible dosages of oseltamivir (0.1, 1, or 10 mg/kg of body weight per day) or a placebo. The highest dosage was proportional to the dosage humans receive when treated for the flu. Thirty mice received oseltamivir for 5 days—the same regimen as is recommended for humans—while 30 received the drug for 8 days. Survival rates for the mice depended on their daily dose and regimen length. Five of 10 mice that received 10 mg/kg/day for 5 days survived, but all the mice that received lower doses for 5 days died. Among mice on the 8-day regimen, the survival rates were 1 of 10 on the lowest dose, 6 of 10 on the middle dose, and 8 of 10 on the highest dose. "The eight-day dose of oseltamivir allowed more time for virus levels to fall and less chance for avian flu to rebound after the drug was stopped," the NIAID said. In mice on the 5-day regimen, analysis of the lungs showed that the virus survived and grew again after the treatment ended. Most of the mice that died had severe neurologic symptoms. The researchers found that oseltamivir was less potent against the 2004 Vietnam strain of H5N1 than it had been against the 1997 Hong Kong strain in a previous mouse experiment at St. Jude's. Therefore the investigators compared the virulence of the two strains by assessing their growth and infectivity in chicken eggs, canine kidney cells, and mice. They found significantly higher yields for the 2004 strain than the 1997 strain. "The higher brain and blood titers in mice infected with the VN1203/04 [Vietnam 2004] virus indicated a greater propensity toward systemic spread," the report states. It adds that the higher virulence of the 2004 virus may help explain why oseltamivir didn't work as well against it. "The H5N1 avian flu viruses are in a process of rapid evolution," author Govorkova said in the NIAID release. "We were surprised at the tenacity of this new variant." The researchers also did a genetic analysis to look for any emerging mutations that could make the virus more drug-resistant. They sequenced the neuraminidase and hemagglutinin genes from several viruses isolated from the mice and found no amino-acid changes. The NIAID noted that H5N1 virus was found in the spinal fluid of a Vietnamese boy who died last year, suggesting that the virus is able to infect the human brain. The authors say more research is needed to determine if a higher dosage or longer regimen of oseltamivir might stop the virus from growing in the lungs and spreading to the brain. They conclude that it is "encouraging" that the 2004 virus was sensitive to oseltamivir in mice, even though a longer treatment regimen and higher dosage were required. Yen H, Monto AS, Webster RG, et al. Virulence may determine the necessary duration and dosage of oseltamivir treatment for highly pathogenic A/Vietnam/1203/04 influenza virus in mice. J Infect Dis 2005;192(Aug 15) [Abstract]

Center for Infectious Disease Research & Policy Academic Health Center -- University of Minnesota Copyright © 2006 Regents of the University of Minnesota

Oh, and for anyone following this exchange of ideas....

Are we having fun yet?

No we are not having fun. I don't like being attacked. However thank you for the info that you are basing your increase to 4 capsules a day. However  They didn't mention that they ALSO  extended the time period.  I am aware of this study, and the dosing days is 5. 4 X 5 is 20, not forty. I still stand by the statement that it should be 20, not 40 going by scientific data alone.

Hi, My name's Linda. I have been certified as an EMT and have successfully completed 3 years of a 4 year Nursing degree (BSN). Being a student Nurse does not qualify a person to give medical advice but I’m reading things on here that give me great concern for the health and welfare of the readers and their families who may happen upon this and other forums like it and so I would like to address some of these issues.

The first thing that alerted me to write is that I see a thread on here that is presented as a study and it is not. (no personal attack intended here, this article could easily be mistaken as a scientific study; it is however an article written by a journalist who more than likely does not have a background in science).

I have read the article but have not read the full study but in reading the abstract (there is a link at the bottom of the article in the thread) I did not find any suggestion that humans should double their dose....I did see that mice were given the dose mentioned in the article 2 times a day. Another important fact (1 of many) that the journalist left out was the amount of time between the dose of virus and the first dose of tamiflu. ( it was just a few hours).

One might think then that the journalist is correct in saying a double dose to humans is the logical conclusion but then I have no idea if the journalist has a reliable source and so have no way of knowing if 10 mg per kg for a rat is an actual equivalency of the recommended human dose. this was not one of the conclusions mentioned in the abstract of the actual study.

Taking this line of reasoning a step farther I would also have to ask if this is supposed to be equivalent to the human dose that is recommended as a prophylaxis for influenza or for treatment at onset. ( Two very different recommendations... hmm...I hope this is making you think! ). Recommended doses also vary by age and according to medical history which brings me to my next point.

....If you do not have a Primary Care Physician please find one....This person should know your personal medical background....You are not a lab rat and there may be things in your medical history that could effect or be affected by medications. ( a couple exampleas of many below)

I will say that according to my 2003 edition of the PDR Nurses drug handbook by G. Spratto, PhD and A. Woods, MSN, ARNP, FNP-C, that it is states (under Nursing Considerations of Tamiflu) several points; one of many being that Tamiflu may aggravate diabetes control and another that use for children under the age of 13 must be provider initiated as it could cause more diverse effects in children than indicated. pp1084-1085.

Ok. Now you are saying to yourself that those considerations are not indicated for a deadly virus and that nothing is worse than death. Of course this is true but shouldn’t you know what those effects might be so you can be prepared to deal with them, should the need arise?

Please people do not give (or take) medical advice in an open forum no matter how honorable your intensions may be. Please do not say “I am taking this amount or that amount and think that it’s ok to say it“...it is not ok. Someone out there might read it and believe that this is a good dose for them even if you didn’t mean to suggest that it was. The person on here that wrote the amount that their Dr. suggested for them needs to understand that by saying it was Dr. recommended you may have validated in someone’s mind that your recommended dose might be ok for them.

Isn’t the point you were trying to make that you discussed the possibility of the flu and medications with your Dr. and he or she gave you and your family an appropriate prescription?

Please, be careful what you write....The pen is swifter than the sword.

Gimme wrote: Hi All, I am newbie on this forum.  I don't know if you all have covered this in your discussions but I think it was Dr. Osterman <-- sp who said there are no studies done that Tamiflu acutally helped those who were sick with the flu.  Those who were treated vs. those not receiving Tamiflu. ( IF those with who received tamflu would have recovered regardless?)  And in another article I read there were some severe side effects to youngsters in Japan who had received it.  So, just how helpful would it be to take the stuff vs. nothing I guess?? Can anyone update me? Thanks.

I would advise you to consult with a physician before you make up your mind. That being said...

Tamiflu does not stop the virus from entering healthy cells, rather, it stops the virus from leaving a healthy cell to infect others. It mitigates the damage and helps you to survive, it's not a cure.

There are scientific abstracts posted in the forum here that
suggesting that the amount of Tamilfu
and duration of treatment will be predicated
on the pathogenic nature of the virus. My 2-cents.

* Use the forum "Search" feature to data mine this site. Scroll to the upper   
   right-hand corner and click on "Search". You can't know the players
   without a program.

J Infect Dis. 2005 Aug 15;192(4):665-72.

Virulence may determine the necessary duration and dosage of oseltamivir treatment for highly pathogenic A/Vietnam/1203/04 influenza virus in mice.

Yen HL, Monto AS, Webster RG, Govorkova EA.

Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.

BACKGROUND. Control of highly pathogenic avian H5N1 influenza viruses is a major public-health concern. Antiviral drugs could be the only option early in the pandemic.

METHODS. BALB/c mice were given oseltamivir (0.1, 1, or 10 mg/kg/day) twice daily by oral gavage; the first dose was given 4 h before inoculation with H5N1 A/Vietnam/1203/04 (VN1203/04) virus. Five- and 8-day regimens were evaluated.

RESULTS. Oseltamivir produced a dose-dependent antiviral effect against VN1203/04 in vivo (P<.01). The 5-day regimen at 10 mg/kg/day protected 50% of mice; deaths in this treatment group were delayed and indicated the replication of residual virus after the completion of treatment. Eight-day regimens improved oseltamivir efficacy, and dosages of 1 and 10 mg/kg/day significantly reduced virus titers in organs and provided 60% and 80% survival rates, respectively (P<.05). Overall, the efficacy of the 5- and 8-day regimens differed significantly (death hazard ratio, 2.658; P<.01). The new H5N1 antigenic variant VN1203/04 was more pathogenic in mice than was A/HK/156/97 virus, and a prolonged and higher-dose oseltamivir regimen may be required for the most beneficial antiviral effect.

CONCLUSIONS. Oseltamivir prophylaxis is efficacious against lethal challenge with VN1203/04 virus in mice. Viral virulence may affect the antiviral treatment schedule.

PMID: 16028136 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16028136&query_hl=7&itool=pubmed_docsum
    

    
    

Thanks FM!

Rick & Fla Medic

Ya know Diane, I think I'm gonna nominate you for Moderator in Charge of Chapping SZ's butt.

Not wanting to turn this into a tag-team match, but I will say that the doctors I've spoken to (several, btw) all seem to side with SophiaZoe on this one.  They believe that Tamiflu must be given in larger, and longer, doses than originally thought.

One doctor believes 30 pills (3/day for 10 days) is a minimum he would recommend. Another said 40 pills (4/day for 10 days).  A third doctor believes the loading dose should be much higher the first 2 days (6 pills day 1- 40 pills ttl).  And yet another has suggested stretching out 40 pills over 14 days makes some sense!

Guess what, guys. They are all offering opinions.

Yep, that's what doctors do.  Hopefully an informed opinion, but usually based on whatever the last pharmaceutal rep told them when they delivered samples, pens and scratch pads to the office.

We are all entering uncharted territory here.  The prudent reader will recognize that anything proffered on this forum is not specific medical advice. 

Today, all evidence on Tamiflu is annecdotal when dealing with H5N1.  I personally believe it can be beneficial.  That may change as the virus evolves. I also believe, based on conversations with doctors and my reading, that the standard dose is not going to cut it.

Diane and Linda, I understand your being wary of medical information, which runs contrary to `established medical protocols', being disseminated on the web.  In normal times, I would agree.  These are not, however, normal times.  People need to know now, that 10 or 20 capsules of Tamiflu may not be enough.  That way they can get more, if they decide to go that route.

A week from now, or a month from now, perhaps we learn more, and can direct people to better sources of information. Until then, it's only prudent to let those here know what the current thinking is on a variety of subjects. Medicine included.

Frankly I see nothing wrong with SZ's analysis. It matches my own, and that of a number of doctors I've spoken to. 

Whether it's right or not, we'll know after the pandemic is over. 

   I have previously posted why drinking  urine does not work and made reference to a very technical article that explains this . Basically tamiflu is oseltamivir phosphate which is highly absorbed from the GI tract. This is excreted in the urine as oseltamivir carboxylate. The carboxylate is poorly absorbed in the GI tract therefore drinking urine does not work.  Also I posted an 8 day 10 pill tamiflu and twice a day  probenecid regimen that will result in fairly high  sustained blood oseltamivir levels. The researchers are hopefully going to give us better guidance in the future but an official optimum regimen currently does not exist.  Go to my previous posts under Frisky for details.  Also I strongly recommend against  using what may be very precious  tamiflu  for prophylaxis considering the very limited supply .  The best strategy [Personal opinion ] is to start treatment  within hours of disease symptom onset.   ER Doc