Written by Kimiko Dunbar
Spoon Feed
Despite national guidelines, children at high risk of complications from influenza only receive antivirals about 50% of the time.
What’s up with our 50% success rate?
The IDSA, AAP and CDC recommend that all children at high risk receive antiviral treatment regardless of symptom duration. This retrospective cohort study evaluated antiviral use in 369,756 commercially insured U.S. children ages 1-18 at high risk for influenza complications from 2016–2020. Hospitalized children were excluded from the study because medication dispensed in the hospital was not captured in the database. Despite guideline recommendations, only 54% received antivirals within two days of diagnosis. Antiviral use was more likely in children with asthma (aRR 1.08) or seen in urgent care (aRR 1.51), but lower among younger children, ED visits, and high-deductible plans. Limitations include lack of symptom onset data and vaccination records, as well as examination of only dispensed prescriptions – we don’t know how many were prescribed the medication but unable to fill it.
How does this change my practice?
This is a good reminder that all children with risk factors should be prescribed antivirals regardless of symptom duration. As a hospitalist, I should in theory be ordering antivirals for all patients (guidelines suggest antivirals for any child sick enough to be hospitalized), but I am certainly guilty of not prescribing for late presentations, especially in those with significant GI symptoms. It’s interesting that children <1 and hospitalized children were excluded from the data. I imagine including this population would increase the overall percentage of kids being prescribed antivirals when indicated.
Source
Factors Associated with Antiviral Drug Use Among Commercially Insured Children at High Risk for Complications of Influenza. J Pediatr. 2025 Apr 2;282:114574. doi: 10.1016/j.jpeds.2025.114574. Epub ahead of print. PMID: 40185310
