Monday, October 5, 2009

Tamiflu in the River

Intriguing thread on ProMED about Tamiflu contamination of rivers in Japan. Apparently, when we take Tamiflu, we pee out the active form of the drug. Our Tamiflu-pee then travels through the sewage system and eventually ends up back in the environment.

This process has been found with a number of drugs. Several studies of the river which flows into the lake where my drinking water comes from have found high levels of antidepressants and birth control in the water. So we have mellow fish who don't reproduce (That's a joke of course, but the medicine is there and it gets in the fish).

Drugs in the water can have an effect the wildlife and one wonders (suspects) if we end up drinking them again. In the case of Tamiflu, there is a potential for waterfowl to consume the water and breed resistance. The studies that have been done so far suggest that the Tamiflu will survive through the water treatment process. There is a potential for all of us to drink the water and breed resistance.

While the CDC continues to stress limited use of Tamiflu, patients often demand the drug, and some healthcare providers continue to use it liberally. In recent weeks, a child with no underlying health conditions died in area and the media covered it judiciously. The child was taken to the doctor and had rapid results positive for influenza A. The child did not meet the recommendations for receiving Tamiflu and was not prescribed the drug. A few days later the child died. A sad, tragic story, to be sure. And speaking as a parent and not a public health official, if my child were diagnosed with influenza, after hearing that story I would be afraid. You never know which patient will be the one that goes horribly wrong. Many, many parents have called me, terrified because their kid has flu but their doc won't give them Tamiflu. In 99% of those cases, their child will be fine. But there's that 1% chance. That risk that your child will be the one on the news next time.

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