title: Five years of non-prescription oseltamivir: effects on resistance, immunization and stockpiling.
abstract: OBJECTIVE
  In 2007 New Zealand (NZ) became the first country to make oseltamivir (Tamiflu®) available off-prescription. This study investigated the extent of pharmacist supply of oseltamivir over 5 years, including during the influenza A(H1N1) pandemic, and the impact of pharmacist supply of oseltamivir on influenza virus oseltamivir susceptibility, personal stockpiling and influenza vaccine uptake.
  
  
  METHODS
  Randomly selected community pharmacies in NZ reported oseltamivir provision by prescription and through pharmacist supply from 1 January 2007 to 15 September 2011. Oseltamivir resistance data on influenza viruses isolated during influenza surveillance from 2008 to 2011 were obtained, along with influenza vaccine uptake data from 2005 to 2011 and influenza detection data.
  
  
  RESULTS
  Seventy of 85 eligible pharmacies completed the study (82% response rate). Most supplies of oseltamivir throughout the 5 years were dispensed against a prescription rather than pharmacist supplied, with pharmacist supply responsible for 11% of supplies during the pandemic years (2009-10) versus 27% and 31% during 2007 and 2008, respectively. Pharmacist-supplied oseltamivir did not appear to be associated with the development of resistance, with identified likely stockpiling or with a decline in influenza immunization. Pharmacist supplies largely matched the timing of influenza in the community and peaked in June 2009, as did prescription supplies.
  
  
  CONCLUSIONS
  Five years of non-prescription oseltamivir in NZ has resulted in no significant change in the development of resistance or rates of influenza immunization. Supplies remained modest and significant consumer stockpiling through pharmacist supply has not occurred, even during the influenza A(H1N1)pdm09 pandemic in 2009 and 2010. Pharmacists could be better utilized in ensuring fast distribution of antivirals to influenza sufferers during a pandemic.
authors.affiliation: Department of General Practice and Primary Healthcare, University of Auckland, Private Bag 92019, Auckland Mail Centre 1142, New Zealand. n.gauld@auckland.ac.nz
authors.forename: Natalie J
authors.initials: NJ
authors.lastname: Gauld
authors.forename: Lance C
authors.initials: LC
authors.lastname: Jennings
authors.forename: Chris
authors.initials: C
authors.lastname: Frampton
authors.forename: Q Sue
authors.initials: QS
authors.lastname: Huang
mesh_terms: D000998:Antiviral Agents / Q000600:supply & distribution* / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000187:drug effects / Q000302:isolation & purification; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000188:drug therapy* / Q000517:prevention & control*; D009520:New Zealand; D053139:Oseltamivir / Q000600:supply & distribution* / Q000627:therapeutic use*; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D000998:Antiviral Agents; D007252:Influenza Vaccines; D053139:Oseltamivir