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Antivirals underused for children hospitalized with influenza

January 24, 2017

By Will Boggs MD

NEW YORK (Reuters Health) - Antiviral medications are underused for children hospitalized with influenza, according to a study covering 46 children's hospitals during the 2007-2015 influenza seasons and the 2009 H1N1 pandemic.

"Children in high-risk groups for complications from influenza were not any more likely to receive antiviral therapy than others," Dr. Adam L. Hersh from the University of Utah School of Medicine in Salt Lake City told Reuters Health by email.

The U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommend that all children hospitalized with influenza receive an antiviral medication, yet earlier studies have shown that antivirals are underused for these children.

Dr. Hersh's team used data from members of the Pediatric Health Information System network to characterize the patterns of antiviral use among hospitalized children with influenza, including those with high-risk conditions.

Among nearly 36,000 children hospitalized with an influenza diagnosis, 69% had an antiviral prescribed. The rate varied from 38% to 83% among these 46 hospitals, the researchers report in JAMA Pediatrics, online January 23.

During the pandemic season, only 20% received an antiviral. Following the pandemic, 69% received an antiviral.

In the latest influenza season studied (2014-2015), antiviral use ranged from 42% to 90% across the network of hospitals.

Children with a high-risk condition were only slightly more likely to receive an antiviral (70%) than were children without a high-risk condition (67%).

"This is an area where antimicrobial stewardship programs and clinical pharmacists can use tools including guidelines and computerized decision support to ensure that the clinicians taking care of these patients are aware of the diagnosis of influenza and the benefits to early initiation of antiviral therapy in the highest-risk patients," Dr. Hersh concluded.

Dr. Suchitra Rao from Children's Hospital Colorado and the University of Colorado, Aurora, told Reuters Health by email, "Providers need to be aware of the current recommendations from the Centers for Disease Control and Prevention and the American Academy of Pediatrics that all hospitalized patients should receive antivirals, such as oseltamivir, regardless of onset of symptoms or illness severity."

"Observational cohort studies have shown that early antiviral use in hospitalized children with influenza has been associated with a decreased hospital stay length, decreased likelihood of ICU admission, and decreased need for mechanical ventilation," she said. "Other observational studies have suggested that treatment may improve survival."

"While use has increased following the 2009 pandemic, there is still significant room for improvement," said Dr. Rao, who was not involved in the new work.


JAMA Pediatr 2017.

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