New Rules Allow GPs to Prescribe Flu Antivirals Anytime

A New Chapter in Influenza Management

In 2025, regulatory authorities announced a significant change in primary care: general practitioners (GPs) across the UK and many other regions can now prescribe influenza antivirals year-round, breaking away from the traditional “seasonal window” restrictions.

This reform reflects years of evidence suggesting that influenza is no longer a purely seasonal threat, that high-risk patients need access to antivirals beyond winter, and that the healthcare system benefits from early and flexible interventions. The decision is part of a broader public health strategy to reduce complications, prevent hospitalizations, and modernize pandemic preparedness.

The Previous System: Restrictive Seasonal Prescribing
For decades, GPs could only prescribe flu antivirals—such as oseltamivir (Tamiflu), zanamivir (Relenza), baloxavir marboxil, and peramivir—during periods officially designated as “flu season.” This was typically between late autumn and early spring, when surveillance systems confirmed community transmission.

The rationale for restriction was:

• Cost-effectiveness: limiting prescribing to periods of widespread flu activity.
  
  
• Resistance concerns: minimizing inappropriate use and slowing the development of antiviral resistance.
  
  
• Historical epidemiology: influenza was once seen as a sharply seasonal disease, peaking in winter months.

However, these restrictions often frustrated clinicians, especially when they encountered high-risk patients presenting outside the official flu window.

The New Rules: Year-Round Access
Under the new regulations, GPs can now prescribe antivirals for influenza at any time of the year, provided clinical suspicion or testing supports the diagnosis.

Key Aspects of the Policy Change

1. Patient-Centered Flexibility
   • No need to wait for “flu season declaration.”
     
     
   • GPs can treat high-risk individuals (elderly, immunosuppressed, pregnant women, and patients with chronic diseases) whenever influenza is circulating.
2. Diagnostic Support
   • Greater integration of point-of-care testing (POCT) for influenza A and B.
     
     
   • Emphasis on rapid decision-making within the 48-hour treatment window.
3. Public Health Surveillance
   • Prescribing data will feed back into surveillance systems to track influenza activity throughout the year.
4. Pharmacy and Hospital Integration
   • Community pharmacists and secondary care providers will align with GP prescribing practices to ensure continuity.

Why the Change?
1. Year-Round Influenza Transmission
Global surveillance over the past decade revealed that influenza is not strictly seasonal. Off-season outbreaks—often triggered by international travel, shifting viral evolution, or climate variations—have been increasingly documented.

2. COVID-19 Pandemic Lessons
COVID-19 blurred the lines of seasonality and highlighted the need for rapid antiviral access. Authorities recognized that waiting for formal “season declarations” delayed treatment and put vulnerable patients at unnecessary risk.

3. Protecting High-Risk Populations
High-risk patients present to clinics year-round. Denying antivirals in spring or summer led to preventable hospitalizations and even deaths in some cases.

4. Globalization and Travel
Influenza strains circulate globally, with southern hemisphere activity often seeding northern hemisphere cases off-season. International travel accelerates this process.

5. Resistance and Stewardship
Interestingly, restricting antiviral use seasonally did not prevent resistance from emerging. Stewardship now focuses on appropriate use, not restricted timing.

Clinical Implications for General Practice
1. When to Prescribe
GPs are encouraged to prescribe antivirals:

• Within 48 hours of symptom onset in otherwise healthy patients with confirmed influenza.
  
  
• Beyond 48 hours in high-risk or severely ill patients where clinical benefit is still possible.

2. Which Patients Benefit Most

• Adults ≥65 years
  
  
• Pregnant women
  
  
• Patients with chronic cardiovascular, respiratory, renal, hepatic, or neurological disease
  
  
• Immunocompromised patients
  
  
• Children under 5, particularly <2 years

3. Choice of Antiviral

• Oseltamivir (Tamiflu) remains first-line due to oral availability.
  
  
• Zanamivir (Relenza) for oseltamivir-resistant strains or contraindications.
  
  
• Baloxavir marboxil offers a single-dose oral alternative with promising efficacy.
  
  
• Peramivir (IV) reserved for hospital or severe cases.

4. Diagnostics in Primary Care
With POCT now more widely available, GPs can confirm influenza in 15–30 minutes, supporting rational prescribing and differentiating from COVID-19 or RSV.

Benefits of Year-Round Prescribing

1. Faster Treatment = Better Outcomes
   Starting antivirals early reduces symptom duration, transmission, complications, and hospitalizations.
   
   
2. Reduced Secondary Complications
   Influenza is a major trigger for bacterial pneumonia, COPD exacerbations, and decompensation of chronic diseases. Early treatment reduces these risks.
   
   
3. Equitable Access
   High-risk patients no longer face arbitrary denials based on calendar dates.
   
   
4. Better Surveillance Data
   Tracking antiviral prescribing year-round provides real-time epidemiological insights.
   
   
5. Preparedness for Future Pandemics
   Establishing routine antiviral readiness strengthens response capacity for emerging influenza pandemics.

Potential Concerns
1. Overprescribing and Resistance
Unrestricted access may raise fears of overuse. Stewardship education is essential, ensuring antivirals are used for confirmed or highly suspected influenza—not every viral syndrome.

2. Diagnostic Challenges
Symptoms overlap with other respiratory viruses. Over-reliance on clinical diagnosis could inflate antiviral use without POCT confirmation.

3. Cost Implications
Year-round prescribing increases drug costs, though these may be offset by fewer hospital admissions.

4. Patient Expectations
Patients may pressure clinicians for antivirals for mild, self-limiting illness. GPs must balance reassurance with evidence-based prescribing.

Integrating Antivirals with Broader Influenza Strategy

1. Vaccination Remains the Cornerstone
   Year-round antivirals do not replace flu vaccination. Prevention via annual vaccination remains the most cost-effective and evidence-based strategy.
   
   
2. Public Messaging
   Authorities must clarify that antivirals are not substitutes for vaccines but complementary tools.
   
   
3. Antiviral Stockpiling
   Governments and health systems must manage supply chains to avoid shortages, particularly if year-round prescribing drives demand spikes.
   
   
4. Global Coordination
   This policy may influence other countries to adopt similar year-round access, harmonizing global influenza management.

Lessons for Other Infectious Diseases
This shift sets a precedent. If antivirals for flu can be prescribed year-round, what about:

• RSV antivirals and monoclonals for high-risk infants and adults?
  
  
• COVID-19 antivirals as enduring part of general practice?
  
  
• Broad-spectrum antivirals for pandemic preparedness?

We may be entering a new era where primary care physicians routinely prescribe antivirals as they do antibiotics, but with better stewardship safeguards.

Practical Advice for GPs

• Stay updated on antiviral resistance patterns via national guidance.
  
  
• Incorporate POCT where available to guide prescribing.
  
  
• Counsel patients on benefits and limitations—antivirals reduce illness duration and complications but are not cures.
  
  
• Document carefully the clinical reasoning behind prescribing decisions, especially outside peak season.
  
  
• Reinforce vaccination at every opportunity.

Key Takeaways

• GPs can now prescribe flu antivirals year-round, not just during declared flu seasons.
  
  
• The change reflects global influenza epidemiology, patient safety, and lessons from COVID-19.
  
  
• High-risk patients stand to benefit most from flexible prescribing.
  
  
• Antiviral stewardship, diagnostics, and ongoing surveillance remain critical.
  
  
• This is a paradigm shift in primary care, integrating antivirals into routine medical practice alongside vaccines.