Despite guidelines, few US children receiving flu antivirals

sick child in hospital

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National guidelines recommend the use of antiviral drugs in children diagnosed with influenza, but only 30% of children and adolescents at higher risk for influenza complications were prescribed antivirals during outpatient visits, according to a study yesterday in Clinical Infectious Diseases. 

Notably, almost 37% of infants six months and younger—who are not yet eligible for flu vaccination—were not treated with antivirals when hospitalized for the flu. 

The findings were based on 1,213 children with lab-confirmed flu seen at seven pediatric medical centers in the Centers for Disease Control and Prevention (CDC)-funded New Vaccine Surveillance Network (NVSN) between December 1, 2016, and March 31, 2020. Cities included in the study were Cincinnati, Ohio; Houston, Texas; Kansas City, Missouri; Nashville, Tennessee; Pittsburgh, Pennsylvania; Rochester, New York; and Seattle, Washington.

The median age of patients with confirmed cases was 3.7 years. Most patients were boys (55.6%), had public insurance (64.3%), and did not receive antivirals prior to admission (89.9%), the authors said. In total, 652 children (53.8%) were treated with antivirals. 

Clinical testing associated with antiviral use 

Clinical testing was associated with antiviral use, but only 63.0% of children received clinical influenza testing. Of those, 67.4% received an antiviral. Among the 561 (46.2%) children who did not receive an antiviral, 263 (46.9%) were not clinically tested for influenza. 

Factors associated with higher odds of antiviral receipt included prehospitalization antiviral receipt (adjusted odds ratio [aOR], 2.34; 95% confidence interval [CI], 1.49 to 3.67) and intensive care unit admission (aOR 1.53; 95% CI, 1.02 to 2.29). Children who were immunocompromised due to cancer treatment or blood disorders were also more likely to receive antivirals. 

Patients had lower odds of receiving antivirals if symptoms lasted 2 or fewer days (aOR 0.40; 95% CI, 0.30 to 0.52). There was high variability of site-specific antiviral use, ranging from 26.2% to 73.7%.

Use hasn’t changed in past decade 

The authors noted that a 2015-16 flu season review found that pediatric hospital use of antivirals was 52%. 

The reasons for lack of treatment of children hospitalized with symptomatic influenza illness are unclear.

“Our current analysis indicates that there was minimal change in the subsequent years; adherence to guidelines for antiviral use in hospitalized children remains suboptimal,” they wrote. “The reasons for lack of treatment of children hospitalized with symptomatic influenza illness are unclear.”

In a press release on the study from Vanderbilt University Medical Center, study author James Antoon, MD, PhD, MPH, said, “Our findings of limited use of antivirals in hospitalized children with influenza illness is concerning. Use of these antivirals reduce how long children have symptoms and prevent influenza complication.”

 

 

 


 

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