Early oseltamivir associated with better flu outcomes in children

Early use of oseltamivir in hospitalized children with influenza led to better outcomes, according to the results of a large study published in JAMA Pediatrics.

Co-author Patrick S. Walsh, MD, MS, from the division of emergency medicine at Cincinnati Children’s Hospital Medical Center, told Healio that the inspiration for the study came during his fellowship.

“At the time, we were starting influenza season, and I was looking at the recommendations for the drug oseltamivir to be given to most patients that we were treating, and I was honestly questioning the evidence for it a little bit,” Walsh said. “We noticed there [weren’t] a lot of existing data in the pediatric inpatient setting.”

Walsh and colleagues used the Pediatric Health Information System to find 55,799 pediatric influenza-associated encounters with oseltamivir from 36 different hospitals, from 2007 to 2020. Of the total number of encounters, 33,207 of the patients (59.5%) received oseltamivir early in their hospitalizations.

“We looked at outcomes that we thought would be logical and important for the proposed mechanism of action,” Walsh said. “Those included length of stays, readmission rates within 7 days after discharge, transfers to the ICU after being initially on a regular hospital floor, and then a composite outcome of death, which would be kind of our marker of critical treatment failure.”

Children who received early oseltamivir experienced shorter hospital stays (3 days vs. 4 days), and lower odds of 7-day readmission (3.4% vs. 4.8%), late ICU transfer (2.4% vs 5.4%) and in-hospital mortality or use of extracorporeal membrane oxygenation (0.9% vs 1.3%) compared with children not treated with early oseltamivir.

“The slightly improved outcomes for all of our secondary outcomes as well was a little bit surprising to me,” Walsh said.

He cautioned that the data came from an observational trial rather than a randomized clinical trial.