Oseltamivir and zanamivir may be supplied by community pharmacists “at NHS expense”, England’s chief medical officer, Chris Whitty and chief pharmaceutical officer for England, David Webb, confirmed in a letter to community pharmacies last week (November 24).
This is in line with guidance issued by the National Institute for health and Clinical Excellence (NICE) and Schedule 2 of the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004, which recommends oseltamivir and zanamivir to prevent influenza, they added.
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It comes as surveillance data from the UK Health Security Agency (UKHSA) indicates that influenza is currently “circulating in the community”, Professor Whitty and Mr Webb noted.
In England, antiviral medicines may be prescribed at any time in the secondary care setting for patients with suspected seasonal influenza infection.
However, prescribers in primary care may only prescribe these medicines under the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc) Regulations 2004 when influenza is believed to be circulating within the community.
Antivirals must be issued “promptly”
Pharmacists must ensure antiviral medicines are issued to patients “promptly”, Professor Whitty and Mr Webb advised.
If pharmacies are unable to fulfil the whole prescription, “you should consider how best to assist patients gain timely access to antivirals”, they added.
This may include checking whether other community pharmacies locally have stock.
If they do, they should make arrangements for the patient to collect the stock from that pharmacy.
Alternatively, they should make arrangements for the collection of this stock, they suggested.
In a note announcing the change, the Pharmaceutical Services Negotiating Committee (PSNC) highlighted that FP10 prescriptions, either written generically or by brand, must be endorsed correctly by prescribers under the selected list scheme (SLS) for pharmacies to be reimbursed for dispensing them.
If the SLS endorsement is missing, “the prescription should not be dispensed and will not be passed for payment by NHS Prescription Services”, PSNC said.
“Pharmacy staff cannot make the SLS endorsement themselves,” it added.
Who can be prescribed oseltamivir and zanamivir?
Patients in clinical at-risk groups, “as well as anyone at risk of severe illness and/or complications from influenza if not treated”, may be prescribed the antivirals, Professor Whitty and Mr Webb noted.
Patients prescribed oseltamivir should begin taking the medication within 48 hours of the onset of symptoms.
For zanamivir, treatment should begin within 48 hours of the onset of symptoms for adults and within 36 hours of the onset of symptoms for children, aged five or over.
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For children over 12 months and adults who are not able to swallow capsules, oral oseltamivir suspension may be prescribed.
“Clinical diagnosis of influenza may be challenging given its similarity in presentation to COVID-19,” they noted.
“This situation complicates recommendations for antiviral use based on clinical-epidemiological evidence alone.
“As such, virological testing should be increasingly considered to guide case management and outbreak response,” they added.
