Kids + The Flu – Do Antivirals Help?

October 14, 2021

Written by Rebecca White

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In children hospitalized with the flu, initiation of antiviral therapy within two days of symptom onset was associated with significantly shorter hospitalization time in children with underlying medical conditions or who required ICU level care.

Why does this matter?
Influenza kills hundreds of children each season, and co-infection with COVID-19 certainly complicates things. While antiviral treatment is recommended for all patients hospitalized with influenza, there is limited evidence in children (here are the most recent IDSA guidelines to refresh your memory). Does antiviral therapy actually help in kids hospitalized with the flu?

Going antiviral this flu season…
This retrospective cohort study collected data from the FluSurv-NET database and included children <18 years old with lab-confirmed influenza requiring hospitalization in 2010-2013. The first cohort included 309 children with underlying medical conditions not admitted to the ICU, of which 64% received early antivirals (≤2 days from symptom onset). The second cohort included 299 children requiring ICU admission, of which 56% received early antiviral therapy. 

Children who received early antiviral therapy (almost exclusively oseltamivir) had shorter hospitalizations in both the underlying condition cohort (adjusted hazard ratio: 1.37, P = 0.02) and the ICU cohort (adjusted hazard ratio: 1.46, P = 0.007). Daily discharge probability increased 37% and 46%, respectively, with antiviral therapy. Treatment initiation ≥3 days after symptom onset had no significant effect in either group.

The study is limited by its observational design and some missing data points. Though it’s evident that early antivirals have the potential to shorten hospital stay in those at risk of severe illness from influenza, we need more information on hospitalized non-high-risk and non-ICU pediatric patients. Until we have that answer, I’ll be starting antivirals when admitting a patient for recently diagnosed influenza, regardless of risk factors.

Source
Influenza Antiviral Treatment and Length of Stay. Pediatrics. 2021 Sep 1;e2021050417. doi: 10.1542/peds.2021-050417. Online ahead of print.