Oseltamivir Associated With Improved Outcomes for Younger Patients with Influenza

Oseltamivir is recommended for all children hospitalized with influenza, despite limited evidence supporting its use in the inpatient setting.

A study was conducted to determine whether early oseltamivir use is associated with improved outcomes in children hospitalized with influenza.

This multicenter retrospective study included 55 799 children younger than 18 years who were hospitalized with influenza from October 1, 2007, to March 31, 2020, in 36 tertiary care pediatric hospitals who participate in the Pediatric Health Information System database. Data were analyzed from January 2021 to March 2022.

The primary outcome was hospital length of stay (LOS) in calendar days. Secondary outcomes included 7-day hospital readmission, late (hospital day 2 or later) intensive care unit (ICU) transfer, and a composite outcome of in-hospital death or use of extracorporeal membrane oxygenation (ECMO). Inverse probability treatment weighting (IPTW) based on propensity scoring was used to address confounding by indication. Mixed-effects models were used to compare outcomes between children who did and did not receive early oseltamivir treatment. Outcomes were also compared within high-risk subgroups based on age, presence of a complex chronic condition, early critical illness, and history of asthma.

Results:

• The analysis included 55 799 encounters from 36 hospitals.
• The median (IQR) age of the cohort was 3.61 years (1.03-8.27); 56% were male, and 44% were female. A total of 33 207 patients (59.5%) received early oseltamivir.
• In propensity score–weighted models, we found that children treated with early oseltamivir had shorter LOS and lower odds of all-cause 7-day hospital readmission, late ICU transfer, and the composite outcome of death or ECMO use

Thus, early use of oseltamivir in hospitalized children was associated with shorter hospital stay and lower odds of 7-day readmission, ICU transfer, ECMO use, and death. These findings support the current recommendations for oseltamivir use in children hospitalized with influenza.

Reference:

Walsh PS, Schnadower D, Zhang Y, Ramgopal S, Shah SS, Wilson PM. Association of Early Oseltamivir With Improved Outcomes in Hospitalized Children With Influenza, 2007-2020. JAMA Pediatr. Published online September 19, 2022. doi:10.1001/jamapediatrics.2022.3261

Keywords:

Oseltamivir, Improved, Outcomes, Younger, Patients, Influenza, Walsh PS, Schnadower D, Zhang Y, Ramgopal S, Shah SS, Wilson PM, JAMA Pediatrics