WHO findings on bird flu treatment

on Friday the World Health Organization (WHO) reported the early conclusions of a group of international experts who met last month to compare evidence on treatments, including attempts by some doctors to use steroids in addition to other treatment measures.

The experts conclude that Bird flu patients given early treatment with the antiviral drug Tamiflu have the best chance of surviving but that using steroids can do more harm than good, .

"Corticosteroid therapy has failed so far to show effectiveness," the WHO warned in a statement. "Prolonged or high dose corticosteroids can result in serious adverse events."

Frederick Hayden of WHO's global influenza program said some doctors in Vietnam and Indonesia, had used steroids to try to save quickly deteriorating bird flu patients. Published research showed eight of nine had died.

"A concern is some treatment is of unsubstantiated value and in some instances may be doing more harm than good," he told Reuters.

The WHO confirmed that early treatment with Tamiflu (known generically as oseltamivir reduces mortaality from the H5N1 virus. Giving it to people with advanced symptoms was also "warranted".

"Data presented gave strong support that early treatment makes a difference," Hayden said, citing data from Egypt where 20 of 34 bird flu patients have survived to date.

"Unfortunately the problem is many patients are coming in late with shortness of breath and progressive symptoms that would indicate advanced viral pneumonia," he said.

Tamiflu can also be used at a two-fold higher dosage and possibly in so-called "dual antiviral therapy" with an older class of drugs known as amantadine, the WHO said, in line with previous recommendations.

But such decisions should be made on a case-by-case basis, especially in patients with pneumonia or progressive disease.

Combining Tamiflu with amantadine may be especially useful in countries where the virus is susceptible to amantadine.

These countries include China and parts of Europe and Africa where a particular H5N1 subvirus or "clade" has spread, causing human cases since January 2006, according to Hayden. He cited Turkey, Egypt and Azerbaijan.

Antibiotics should not be given preventively, due to possible resistance and side-effects but according to the WHO should only be given if there is good reason to suspect the patient has a bacterial complication to pneumonia.