Clinicians across the country show considerable nonadherence to guidelines for outpatient use of oseltamivir (Tamiflu) to treat children with flu, according to a study today in Pediatrics.
The study was conducted from March to June 2024 at seven US children’s hospitals and their affiliated clinic with 452 participant pediatric clinicians. Clinicians were given four clinical influenza vignettes, three of which represented scenarios warranting treatment with oseltamivir per national recommendations.
Overall, clinicians were less likely to recommend treatment with antivirals if the patient vignette described someone with symptoms more than 3 or 4 days in length. When symptoms were described as lasting 2 days, 30.9% of clinicians recommended treatment, compared to just 1.8% when symptoms lasted 4 days.
A vignette describing a previously healthy 6-year-old child on day 4 of fever and myalgias (muscle pain), had the lowest percentage of “likely to recommend,” at 1.8%; whereas, a vignette describing an 8-year-old child with an asthma exacerbation on days 3 to 4 of symptoms had the highest percentage of “likely to recommend,” at 50.5%.
At-risk kids should be treated
The only vignette that described a situation where prescribing would not be advised was a 6-year-old child without high-risk factors who was beyond 48 hours of symptom onset. Respondents to this vignette were guideline concordant 98.4% of the time, meaning they were unlikely to recommend oseltamivir, the authors wrote.
Though antiviral use is recommended by the American Academy of Pediatrics (AAP), Infectious Diseases Society of America (ISDA), and the Centers for Disease Control and Prevention (CDC) to begin during the first 2 days of symptoms, all children at risk of severe flu or complications from flu are recommended to receive oseltamivir as long as they are still symptomatic.
Given current data on influenza antivirals, providers should follow AAP, CDC, and IDSA recommendations for prompt treatment of influenza in those at high risk for influenza complications
In a commentary on the study, James Antoon, MD, PhD, MPH, from the Department of Pediatrics at Vanderbilt University Medical Center, wrote, “Studies are needed on barriers and facilitators to antiviral treatment, shortening time to antiviral treatment, comparative effectiveness of antivirals, and serious influenza-related complications. Given current data on influenza antivirals, providers should follow AAP, CDC, and IDSA recommendations for prompt treatment of influenza in those at high risk for influenza complications.
He adds, “The AAP, ISDA, and CDC guidelines are supported by findings from [randomized controlled trials] in children with mild moderate influenza illness in the outpatient setting with primary outcomes of duration of symptoms or time to alleviation of symptoms.”