Bottom line: The Cochrane Collaboration concluded that benefits and harms need to be considered when deciding to use Tamiflu for prevention and treatment of influenza in healthy adults and children. A systematic review of systematic reviews concluded that “the combination of diagnostic uncertainty, the risk for virus strain resistance, possible side effects and financial cost outweigh the small benefits of oseltamivir…for the prophylaxis and treatment of healthy individuals.” Flanner and Bastin stated that additional data is needed to reach a definitive conclusion, but in critically ill patients the current literature “does not support routine use of high-dose oseltamivir in critically ill patients.” Summary of evidence:
Jefferson, Tom, et al. “Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children.” Cochrane Database of Systematic Reviews 4(2014):CD008965. The full report covers the controversy with regard to the efficacy of Tamiflu.
Michiels, Barbara, et al. “The value of neuraminidase inhibitors for the prevention and treatment of seasonal influenza: a systematic review of systematic reviews.” PLoS ONE 8.4 (2013):e60348.
Flannery, Alexander H, and Melissa L Thompson Bastin. “Oseltamivir dosing in critically ill patients with severe influenza.” The Annals of pharmacotherapy 48.8 (2014):1011-1018.