A nearly 15-year study has shown that early oseltamivir improves outcomes in hospitalized children with influenza

Medical Pulse Guide

This nearly 15-year multicenter retrospective study showed that early use of oseltamivir in children hospitalized with influenza was associated with
shorter hospital stays, lower 7-day readmission rates, delayed admission to intensive care units, mortality during hospitalization, or reduced rates of extracorporeal membrane oxygenation.
See below
for details.

Oseltamivir was first approved by the U.
S.
Food and Drug Administration (FDA) in 1999 and recommended by the American Academy of Pediatrics (AAP) and the Infectious Diseases Society of America (IDSA) for the treatment of all hospitalized children
with influenza.
Despite these guideline recommendations, there is controversy
as to whether oseltamivir improves outcomes or reduces resource use in hospitalized children.

Recently, a team of researchers from Cincinnati Children's Hospital Medical Center in the United States conducted a multicenter retrospective study to determine whether early use of oseltamivir is associated with
improved outcomes in children hospitalized with influenza.
The study was published
in JAMA Pediatr.
(impact factor: 26.
796).

Study design

The research team included 55,799 children under 18 years of age hospitalized with influenza between October 1, 2007 and March 31, 2020, from 36 tertiary pediatric hospitals
participating in the Child Health Information System database.
Data analysis was from January 2021 to March 2022
.
Early oseltamivir treatment, defined as oseltamivir
on day 0 or 1 of hospital stay.

The primary outcome was length of hospital stay (LOS).

Secondary outcomes included the combined outcomes
of seven-day readmission, delayed (second day or later) intensive care unit (ICU) transfer, in-hospital death, or use of extracorporeal membrane oxygenation (ECMO).
The inverse probability processing weighting method based on propensity score (IPTW) was used to solve the problem
of indication confounding.
Mixed-effect models were used to compare outcomes in children treated with early oseltamivir with no oseltamivir
.
Results for high-risk subgroups were also compared by age, presence of complex chronic disease, early critical illness, and history of asthma
.

outcome

A total of 55,799 children
from 36 hospitals were included in the study.
The median age (IQR) of the cohort was 3.
61 years (1.
03 to 8.
27 years); 56% were male and 44% female
.
A total of 33,207 patients (59.
5%) received early oseltamivir treatment
.

In the propensity score-weighted model, children treated with oseltamivir early had shorter LOS (median 3 versus 4 days; IPTW model ratio, 0.
52; 95% CI [confidence interval], 0.
52-0.
53); Seven-day readmission rates were lower for all causes (3.
5% vs.
4.
8%; Adjusted odds ratio [aOR], 0.
72; 95% CI, 0.
66-0.
77), delayed ICU transfer (2.
4% vs.
5.
5%; aOR, 0.
41; 95% CI, 0.
37 to 0.
46), combined outcome of death or ECMO use (0.
9% vs.
1.
4%; aOR，0.
63；95%CI，0.
54-0.
73）
。

Figure 1.
IPTW analyzed the prognosis of patients who received oseltamivir early versus those who did not

conclusion

Early use of oseltamivir in children hospitalized with influenza is associated with
shorter hospital stays, lower 7-day readmission rates, delayed ICU transfer, mortality, and reduced ECMO use.
These findings support the recommendation
to use oseltamivir in children currently hospitalized with influenza.

References:

[1] PS W, Schnadower D, Zhang Y, et al.
Association of Early Oseltamivir With Improved Outcomes in Hospitalized Children With Influenza, 2007-2020.
[J].
JAMA Pediatr, 2022 Nov 1; 176(11):e223261.