What to do about Tamiflu?

November 9, 2009

We have a young baby at home and as H1N1 started popping up in clinic and in the school system, I cautioned my older children strongly about being extra careful with hand washing before touching their baby brother.

We have a young baby at home and as H1N1 started popping up in clinic and in the school system, I cautioned my older children strongly about being extra careful with hand washing before touching their baby brother.

When my husband started complaining of a headache and cough, I insisted he check his temperature. The ear thermometer read 101. “Does this thing really work?” he asked me. I felt pretty confident that he had a fever, having already done the more specific “mom test” of a hand against his forehead. “Yes,” I replied. “You’re sick.”

My family members almost always develop illnesses and sustain injuries in the evening hours. This was no exception, and I started working my way through the phone triaging system of our family doctor, trying to get a prescription for Tamiflu for our young baby, as I was concerned that my husband was in the early throes of H1N1 influenza.

While waiting for first the nurse and then the doctor to call me back, I checked my young son’s temperature, encouraged my husband to take Tylenol, segregated my other kids in the playroom, and read up on the latest from the CDC. I debated just calling in the Tamiflu myself. However, the more I thought about it and read the emergency use authorization in children younger than 1 year, I started feeling less confident. Maybe my husband had something else going on. Should I expose my son to a potentially harmful medication if I wasn’t sure that he was exposed to H1N1? How many times would I be putting him on Tamiflu this fall and winter if we considered every febrile illness in our family (of which there are usually many) H1N1?

After several frustrating minutes spent discussing feedings and wet diapers with the triage nurse, I pulled out my doctor card. “Listen, I’m a family physician and I’m pretty sure my son has been exposed to H1N1. I think he needs Tamiflu.”

“Oh,” she replied, “I’ll page the doctor on call right away.”

The on-call doctor was busy juggling an evening clinic with my phone call and admitted that she wanted to look up the latest CDC recommendations and speak with a pediatric hospitalist before prescribing the Tamiflu for my son. I watched the clock, trying to judge how long I could wait until our local pharmacy closed for the evening. The on-call doctor called me back about 45 minutes later. “I’m sorry, when we talked before, I didn’t realize you were a physician. You probably know what I am going to tell you, but this is what I found out.”

She went on to describe the pros and cons of chemoprophylaxis in our particular situation and some of the different ways we could approach the situation. She also acknowledged her own struggle with the Tamiflu issue in her home after one of her children became ill. It was a good conversation and put me at ease as I realized that there was no clear-cut answer, but rather a variety of choices we could make to try to keep my son healthy.

I picked up the Tamiflu that night but held off on giving it to him until my husband’s illness declared itself and our oldest son developed a clear case of influenza. I was glad that I had not made a medical decision on my own but also pleased that I had an opportunity to problem solve with a colleague who respected my role as both a doctor and a mom.

Jennifer Frank, MD, FAAFP, is an assistant professor in the University of Wisconsin Department of Family Medicine and a faculty family physician at the Fox Valley Family Medicine Residency Program in Appleton, Wis. She is a mother of four, whose husband, also a physician, is a stay-at-home dad.