Patients need strict guidelines on antiviral drug

A group of pharmacists yesterday called on the Public Health Ministry to issue strict guidelines for patients to follow with regard to the oseltamivir antiviral drug, so adverse reactions and fatalities can be avoided.

"The Public Health Ministry must issue guidelines to type-A (H1N1) patients about exactly how they should store and consume the drug," said Niyada Kiatyingungsulee, from the Chulalongkorn University's faculty of pharmaceutical sciences.

She was speaking at the annual academic conference held by the Thai Health Promotion Foundation.

The move comes after the Public Health Ministry yesterday gave permission to private clinics nationwide to prescribe oseltamivir for patients with severe flu-like symptoms.

So far, the Public Health Ministry had only issued guidelines for clinicians, but none advising patients on the appropriate use of the medication.

An antiviral, used to slow down the spread of the influenza virus, is a special-control medication and can only be prescribed by hospitals.

Patients need to strictly follow the prescription until they recover and store tablets at room temperature, between 15 and 30 degrees Celsius, and the suspension formula at 2 to 8 degrees. Niyada said the oseltamivir suspension formula, usually prescribed for children, has to be stored in an amber-coloured bottle and shaken before consumption.

The Government Pharmaceutical Organisation (GPO) will also produce one million capsules of oseltamivir meant especially for children, GPO director Dr Vitthit Attavejchakul said. The contents of these capsules can be mixed in with sweet liquids so children can consume the drug more easily. However, he said, parents should not mix the drug with milk or have the child consume the drug via a milk bottle.

If patients do not take the medicine appropriately or store it properly, the virus will become resistant making oseltamivir ineffective.

Patients must also inform their doctors if they are taking any other medication before they are prescribed oseltamivir.

Meanwhile, doctors should also be careful about dispensing the drug, because some patients might be allergic to it. Niyada also said that clinics should have young patients seek treatment in hospital.

At present, around 1,200 hospitals and clinics nationwide carry oseltamivir, but only 31 of the 181 clinics registered for experimental use of oseltamivir have agreed to accept the tablets.

Deputy Public Health Minister Manit Noppamornbhodi said the antiviral has been dispensed to 42 patients with flu-like symptoms from July 28 to August 2 in Ratchaburi province.

Dean of Mahidol University's Faculty of Medicine, clinical professor Dr Teerawat Kulthanan said more than 20,000 people sought treatment for influenza since the type-A (H1N1) virus hit the country in May. However, so far the virus has not been reported to be resistant to the drug.

Public Health Minister Witthaya Kaewparadai said he was thinking about the most effective way to get the public to understand more about the disease and to protect themselves.

"Few people have read the manual and learned how to prevent infection," he said. "Not only do people not read manuals, but also not every doctor reads the clinical practice guidelines."

The ministry's advisory committee on public health and medicine, chaired by leading virologist Prasert Thongcharoen, said the ministry should conduct in-depth research about the impact brochures on the disease prevention and self-care management released by politicians and academics are having on people.