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When to Use Oseltamivir in Kids (and others…)

December 9, 2022

Written by Aaron Lacy

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Early administration of oseltamivir in children hospitalized for influenza reduced length of stay, decreased 7-day readmission, need for critical care, and ECMO or death.

Why does this matter?
Each year influenza runs rampant, and this year is looking rough. With shortages of oseltamivir around the nation, we need to know if the medicine is effective, and we need to remind ourselves who should be getting it.

Tamiflu, for you?
This was a retrospective, multicenter review of 55,799 children hospitalized with influenza across 36 hospitals between 2007 and 2020. 33,207 children received oseltamivir, average age 3.61. Children treated with oseltamivir had a shorter length of stay (median 3 vs 4 days), lower 7-day readmission rate (3.4% vs 4.8%; aOR 0.72, 95% CI 0.66-0.77), reduced need for transfer to ICU (2.4% vs 5.5%; aOR 0.41, 05% CI 0.37-0.46), or a composite outcome of need for ECMO or death (0.9% vs 1.4%; aOR 0.63, 95% CI 0.54-0.73).

This is compelling evidence for oseltamivir – but in a specific population. While oseltamivir can reduce the length of symptoms in all-comers, IDSA guidelines are clear on who should get it. This includes the population in this review. Given the national shortage of this medication and relatively high side effect profile (i.e. 1 in 19 kids vomit), I will be sticking to the list below before administering or prescribing oseltamivir.

IDSA Guidelines on Neuraminidase inhibitor Administration

It’s not just for kids. These groups also benefit from neuraminidase inhibitors, even if outside a 48-hour window of symptom onset:

  • All hospitalized patients
  • Outpatients with progressive or severe disease
  • Outpatients at high risk of complications from influenza (immunocompromised, serious comorbidities)
  • Extremes of age (children <2 years and adults >65 years)
  • Pregnant women and those within 2 weeks postpartum

Association of Early Oseltamivir with Improved Outcomes in Hospitalized Children with Influenza, 2007-2020. JAMA Pediatr. 2022 Nov 1;176(11):e223261. DOI: 10.1001/jamapediatrics.2022.3261.

What are your thoughts?