Early oseltamivir improves outcomes in children with influenza

Early oseltamivir use helps hospitalized children have shorter hospital stays, along with decreasing chances of 7-day readmission, extracorporeal membrane oxygenation (ECMO) use, ICU transfer, and death, according to a recent study.

About 2.8 to 10.7 million children experience symptomatic illnesses, 1.6 to 6.1 million outpatient medical visits, 11,000 to 45,000 hospitalizations, and 110 to 600 excess deaths annually because of influenza. Oseltamivir is the main form of treatment given to patients suffering from influenza, having been approved by the US Food and Drug Administration in 1999.

The median time for alleviation of influenza symptoms among pediatric patients is improved by 29 hours from oseltamivir compared to placebo. Guidelines from the American Academy of Pediatrics and Infectious Diseases Society of America recommend oseltamivir for the treatment of influenza in hospitalized children.

However, there is still debate over whether oseltamivir uses less hospital resources than alternatives, and if patient outcomes are improved. In a 2009 study, oseltamivir use benefitted adults but not children. Other studies indicated successful pediatric use, but these studies had limited sample sizes.

To determine association between oseltamivir use in pediatric patients and improved outcomes, investigators conducted a multicenter retrospective cohort study, with data taken from hospitalized children afflicted with influenza.

Pediatric patients with influenza discharged from a participating hospital from October 1, 2007, to March 31, 2020, were included in the study. Primary exposure was defined as early use of oseltamivir, meaning that children who had taken oseltamivir on day 0 or day 1 of admission were included.

Hospital length of stay (LOS) was the primary outcome, calculated as the distance between admission data and discharge date. Late intensive care unit (ICU) transfer, 7-day hospital readmission, and a composite outcome of in-hospital death or ECMO use were listed as secondary outcomes.

A total of 55,799 encounters across 36 hospitals were included in the study, and the average age of patients was 3.61 years. Nearly 60% of patients received early oseltamivir. In these cases, the median LOS was 3 days instead of 4, and all-cause 7-day hospital readmission, late ICU transfer, and death or ECMO usewere less likely.

Children treated with early oseltamivir were often olderand were more likely to have complex chronic conditions or require early ICU admission. Data on LOS, 7-day readmissions, and late ICU transfers were similar between subgroups, while differences were seen for in-hospital death or ECMO use.

The findings from this study were consistent with current recommendations for early oseltamivir use, indicating that the treatment will lead to improved outcomes in pediatric patients.

Reference

Walsh PS, Schnadower D, Zhang Y, Ramgopal S, Shah SS, Wilson PM. Association of early oseltamivirwith improved outcomes in hospitalized children with influenza, 2007-2020. JAMA Pediatr. 2022. doi:10.1001/jamapediatrics.2022.3261