The Big Question: Could Tamiflu be the wrong way to treat children with swine flu?

Why are we asking this now?

Because researchers at Oxford University say that a review of seven trials on the treatment and spread of flu in 2,500 children suggest that anti-viral drugs – the cornerstone of the government's fight against swine flu – should not be given to children under the age of 12 because their side-effects outweigh their benefits.

They say that Tamiflu caused vomiting in 5 per cent of children, which could lead to dehydration and complications. They are urging the government to rethink its anti-swine flu strategy.

In response the Department of Health says that the review focuses on the use of anti-virals with normal flu not swine flu, which acts differently. It is better to be safe than sorry, it says, and will continue to offer Tamiflu – and the lesser used anti-viral Relenza – to all affected individuals.

What about the other new study?

There are two others, from the Health Protection Agency, which suggests that more than half the children taking Tamiflu have suffered side-effects such as nausea, insomnia and nightmares. That data comes from healthy children at four schools in the south of England who in April and May were given Tamiflu to try to stop them developing swine flu after classmates became infected.

Only 248 pupils were involved in the study but 51 per cent reported side-effects. Of those, 31 per cent felt sick, 24 per cent suffered headaches and 21 per cent had stomach aches. In three of the schools 18 per cent reported a "neuro-psychiatric side-effect" such as poor concentration, inability to think clearly, problems sleeping, nightmares, feeling dazed or confused or "behaving strangely".

Healthy children with poorly classmates are no longer offered the drugs. They are now only available to those diagnosed with swine flu.

What are the benefits of Tamiflu?

The main advantage of anti-viral treatment is to reduce the duration of symptoms by a day. They also reduce the chance of an infected person giving the illness to someone else – though the new research suggests they reduce transmission by just 8 per cent. That means 13 children would have to be treated to prevent one additional case of the flu.

What are the risks?

The drugs can cause unpleasant side-effects. The new research shows that they have little or no effect on asthma attacks, ear infections or other ailments which require antibiotics. There is also the risk that widespread use of the drugs will mean the virus could develop resistance to them.

So where does the balance lie?

The Department of Health, along with the Medicines and Healthcare Regulatory products Agency, both advise that early use of anti-virals can help avoid potentially serious complications. That outweighs the risk of the side-effects. But the Oxford University researchers suggest that the downside of side-effects generally offset the benefit of the one-day reduction in symptoms.

What does the government advise?

The government, which over the last four years has spent more than £500m stockpiling enough of the drug to treat half the population in preparation for a pandemic, has stuck by its policy of offering Tamiflu to anyone who is thought infected. New supplies of the drug are still coming in.

"The extent to which the findings can be applied to the current pandemic is questionable," the Department of Health maintains. "Swine flu behaves differently to seasonal flu, and past pandemics have hit younger people hardest. We believe a safety-first approach of offering anti-virals to everyone remains a sensible and responsible way forward." It has promised to keep the policy under review.

What do the medical experts say?

The government's chief medical officer, Sir Liam Donaldson, insists that Tamiflu should still be given to children if they have the key swine-flu symptoms and there are no existing medical reasons not to prescribe the drug. He has been backed by Professor Steve Field, chairman of the Royal College of GPs, and by the Royal College of Paediatrics and Child Health.

But Peter Holden, the British Medical Association's lead expert on swine flu, has suggested that Tamiflu is being overused. It should not be offered to people with mild symptoms. "The threshold for getting Tamiflu should be quite high," he has said. Patients in high risk groups – pregnant women, people with diabetes, severe asthma or poor immune systems – should contact their GPs, "who will use their clinical judgment."

How bad is the swine flu outbreak now?

There were around 30,000 new cases of swine flu in England in the last week – a lot less than the 110,000 cases the week before. Scotland and Wales have seen a fall too. Most cases have had only mild symptoms.

Children are twice as likely as adults to get swine flu. The under-fives have the highest rate of hospitalisation. Some 800 people are in English hospitals with the disease and 81 of those are in intensive care. The total number of deaths so far in the UK is just 41 of whom 67 per cent had "severe" underlying health problems. By contrast ordinary flu routinely kills 12,000 people in England and Wales each year. The Chief Medical Officer for England has suggested that swine flu infections "may have reached a plateau". Some 300,000 people have so far had Tamiflu.

Might things get worse in the autum?

Possibly. More people get flu then than in the summer usually. And the swine flu virus might mutate. If that happens the virus could develop resistance to the existing anti-virals. That is why the Oxford researchers want less use of Tamiflu now. They say the current policy is as misguided as the cavalier prescription of antibiotics for sore throats was in previous decades. But mutation might not happen. And a swine flu vaccine should be ready in the autumn.

So what if my children fall ill?

Most cases of swine flu are relatively mild. Bed rest, plenty of fluids and over-the-counter flu remedies might suffice if you don't want to ask for Tamiflu. Normal children with healthy immune systems don't usually need anti-viral treatment. But you should remain vigilant for signs of complications.

For those who experience severe symptoms, the best scientific advice suggests that Tamiflu should still be taken as soon as possible. Contact your child's doctor if their condition gets worse or if you have any other cause for concern. You can always call the National Flu Service on 0800 1 513 100. But if in doubt contact your doctor.

Should I give my child Tamiflu?

Yes...

*It shortens the time the disease lasts and it also reduces the rate of transmission to other people

*The studies suggesting it does more harm than good are based on normal flu not swine flu

*If symptoms are severe or there is any sign of complications the safety-first option is to take Tamiflu as soon as possible

No...

*Rest, fluids and over-the-counter medicine should be sufficient for normal kids with mild symptoms

*The side-effects of Tamiflu could outweigh the benefit of it shortening the illness by one day

*The more people who take anti-virals unnecessarily, the greater the risk the virus will mutate into a more resistant strain