Oseltamivir for Healthy Pediatric Inpatients with Influenza Unlikely to Yield Measurable Benefit
Clinical question: What is the benefit of oseltamivir treatment to previously healthy children hospitalized with confirmed influenza infection?
Background: Influenza is generally a mild, self-limited infection that affects all ages but can lead to more serious illness. During the 2012-2013 season, laboratory-confirmed influenza in children zero to four years was associated with a hospitalization rate of 66.4 per 100,000 and 164 pediatric deaths. Currently, the American Academy of Pediatrics and the CDC recommend treatment with either oseltamivir or zanamivir for children hospitalized with influenza. However, despite the recommendations, data are limited regarding the benefits resulting from treating otherwise healthy children hospitalized with influenza.
Study design: Multi-center retrospective study.
Setting: Ten public hospitals in Madrid, Spain, between September 2010 and June 2012.
Synopsis: Researchers identified children ≤14 years admitted to participating hospitals by positive testing with either rapid diagnostic testing or polymerase chain reaction assay of nasal washings. Patients at high risk of serious disease were excluded, including those with chronic disease, immunodeficiency, prematurity (less than 32 weeks gestation), age less than six months at admission, nosocomial infection, and those requiring ICU-level care upon admission. Patients with asthma were included. Decision to treat with oseltamivir was determined by hospital guidelines, with some hospitals treating all hospitalized children with confirmed influenza and others only treating patients with risk factors for severe disease. In addition, only children who had manifested symptoms within 48 hours of admission were included.
Of the 287 children included in the final analysis, 93 were treated with oseltamivir (32%). There were no significant differences between treatment and non-treatment groups in duration of fever, duration of hypoxia, length of stay, or rates of ICU transfer. In addition, the lack of differences in outcomes persisted after subgroup analysis of patients less than one year old.
Bottom line: Treatment with oseltamivir of otherwise healthy children hospitalized with influenza not requiring ICU care is unlikely to yield measurable benefit.
Citation: Bueno M, Calvo C, Mendez-Echevarría A, et al. Oseltamivir treatment for influenza in hospitalized children without underlying diseases. Pediatr Infect Dis J. 2013;32(10):1066-1069.
Reviewed by Pediatric Editor Weijen Chang, MD, SFHM, FAAP, associate clinical professor of medicine and pediatrics at the University of California at San Diego School of Medicine, and a hospitalist at both UCSD Medical Center and Rady Children’s Hospital.
