Why not [symbol: see text]zanamivir?

In 1999, Drug and Therapeutics Bulletin (DTB) and the National Institute for Clinical Excellence (NICE) concluded independently that [symbol: see text]zanamivir (Relenza) should not be used in managing patients with influenza. Recently, reviewing further evidence, NICE revised its position regarding use of zanamivir in 'at-risk' adults: it recommends that, under specific circumstances, the drug should be prescribed for patients at risk who are able start treatment within 48 hours of the onset of influenza-like symptoms. We disagree with this revised advice reasons we explain here.