On June 10, the REMAP-CAP trial released a preliminary result that suggests that oseltamivir (Tamiflu) is not effective, and may be harmful, in adult patients with influenza in critical care. Oseltamivir is the current first-line treatment for influenza in people who are critically ill, provided to 70-80% of patients with influenza in critical care in Australia.
With the peak of the Australian flu season around the corner, ALEC has moved quickly to establish a guideline in collaboration with over 100 clinical experts, researchers, policy makers and people with lived experience. The new guideline will provide timely advice for Australian health professionals in their clinical decision making.
When presented with the results of the trial, many asked about its applicability to children. In response, we have convened a panel of experts in paediatrics, including infectious disease specialists, intensivists, and emergency physicians, to provide guidance for drug treatments for children who are critically ill.
The guideline includes recommendations addressing antivirals (oseltamivir, baloxavir, peramivir, zanamivir), corticosteroids and macrolides in both adults and children. These recommendations only apply to people who are critically ill, with acute actual or imminent organ failure and need for respiratory or haemodynamic support, and do not apply to people with mild or moderate influenza.
The recommendations have been endorsed by the 13 organisations on the guideline Steering Committee, including the Australasian Society for Infectious Diseases, the College of Intensive Care Medicine, the Australian College of Critical Care Nurses and Australian and New Zealand Intensive Care Society.
We have published the guideline as Interim Advice on our website at livingevidence.org.au/influenza where it is now open for public consultation until 8 August 2026. We encourage you to share this update with your networks and provide any feedback regarding the new guideline via our website.
ALEC would like to gratefully acknowledge the rapid, insightful, expert contributions of our magnificent Guidelines Leadership Group, Paediatric Clinical Panel and Lived Experience Panel which enabled development of this guideline.
