Written by Joshua Belfer
Spoon Feed
In a cohort of 1,213 hospitalized children with laboratory-confirmed influenza, about half did not receive guideline-recommended influenza-specific antiviral treatment.
The inconsistent use of flu antivirals
Ensuring timely antiviral treatment in hospitalized children with influenza can reduce complications, ICU admissions, and hospital stays, yet adherence to guidelines remains inconsistent. While national guidelines strongly recommend antiviral therapy for all hospitalized children with influenza, previous studies have shown significant gaps in adherence. This prospective, multicenter surveillance study examined antiviral use in 1,213 children hospitalized with laboratory-confirmed influenza. Despite guidelines, only 53.8% received antivirals. Factors associated with higher antiviral use included ICU admission (aOR 1.53; 95%CI 1.02–2.29), clinical influenza testing (aOR 3.07; 95%CI 2.28–4.14), and immunocompromised status. Longer symptom duration (>2 days) reduced likelihood of treatment (aOR 0.40; 95%CI 0.30–0.52). Antiviral prescribing varied fivefold across sites. This study was conducted at academic pediatric centers, limiting generalizability to community hospitals, and did not assess full adherence to antiviral treatment courses or real-time decision-making influences.
How will this change my practice?
This study reinforces the need for improved adherence to influenza antiviral guidelines in hospitalized children, particularly those with high-risk conditions. While shared decision making may be done for a well appearing child with flu being discharged from the ER, those that are admitted – despite the duration of symptoms – should be started on treatment. A standardized institutional process can help consistency in treatment for those children being admitted with influenza.
Editor’s Note: Clinicians may not have been aware of a significant proportion of the children not treated with antivirals being influenza positive. This greatly overestimates the deficit in guideline adherence, making the study’s conclusions misleading. ~ Nick Zelt
Source
Antiviral Use Among Children Hospitalized With Laboratory-Confirmed Influenza Illness: A Prospective, Multicenter Surveillance Study. Clin Infect Dis. 2024 Dec 17:ciae573. doi: 10.1093/cid/ciae573. Epub ahead of print. PMID: 39688383
