EMERYVILLE, Calif. -- ER Physician, Joseph Howton, MD, supports the use of Tamiflu, an anti-flu drug, with Probenecid, an acid derivative that sustains medicine in the system, as a method of doubling the available supply of Tamiflu to combat a flu pandemic.

In the November issue of the journal, Nature, Dr. Howton explains how he came to this conclusion. i(i) While reviewing data on Tamiflu by Swiss drug maker, Roche, he realized that Probenecid would help inhibit Tamiflu from being secreted by the kidneys, causing the drug to remain in the body longer. According to the article, this technique is similar to methods used during WWII to extend the penicillin supply in a time of major shortages of antibiotics.

Tamiflu attacks the influenza virus and stops it from spreading inside the body. ii(ii) Nature explains that in the past, Probenecid was commonly used in the emergency department as it allows for high, sustained levels of antibiotics in the bloodstream. Dr. Howton told the Australian Broadcasting Corporation (ABC) that Probenecid allows Tamiflu to recirculate and "...you have better virus-killing effect." iii(iii) He adds that the combination can be used in two ways. The first method would be to administer a half-dose or less of Tamiflu along with Probenecid, which would produce "roughly the same levels as if we had just given a full dose," and would "...treat twice as many people with the same amount of drug." Another approach described by Dr. Howton would involve a standard dose of Tamiflu with Probenecid, to "...produce a higher than usual tissue level of Tamiflu," which, he explains "...might actually be necessary for optimal effectiveness."

Although the Tamiflu and Probenecid strategy has been previously researched, Dr. Howton's recent comments have helped revitalize interest in this treatment method. Prentice Tom, MD, Chief Medical Officer for California Emergency Physicians Medical Group (CEP), speculates, "Dr. Howton's comments may even contribute to a change in how we treat the flu worldwide."

Still, in his quote to ABC, Dr. Howton warns the discovery is not an answer to a potential bird flu pandemic. "The only way we're going to prevent massive numbers of fatalities in the event of a major pandemic is by a vaccine," he explains. "The whole idea of a drug like Tamiflu is to buy us time, so that the vaccine can be developed."

Joseph Howton, MD, is Medical Director at Adventist Medical Center in Portland and a Partner of Willamette Emergency Physicians, an affiliate of California Emergency Physicians Medical Group (CEP). CEP was founded in 1975 and is a premier provider of physician staffing, management, and consulting services for Emergency Department and Ambulatory Care Practices in California, Oregon and Georgia. CEP includes more than 1,000 providers who treat almost 2.5 million patients each year. For more information on CEP, visit their website at www.cep.com.

i(i) Butler, Declan. "Wartime Tactic Doubles Power of Scare Bird-Flu Drug." Nature. Vol. 43813 (2005): 6.

ii(ii) Tamiflu. 2 November 2005 http://www.tamiflu.com.

iii(iii) "Combining Drugs May Double Bird Flu Antiviral Supplies." ABC News Online. 2 November 2005 http://www.abc.net.au/news/newsitems/200511/s1496267.htm.

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