Oseltamivir for children admitted with influenza: associated with fewer ICU transfers

Design

Population-based surveillance cohort, time-dependent exposure analysis

Population

6,044 children <18 years admitted with laboratory-confirmed influenza, 2014–2023

Primary outcome

Time from symptom onset to ICU admission

Effect

Adjusted HR 0.69 (95% CI 0.60 to 0.80); discharge HR 1.13 (1.06 to 1.21)

FluSurv-NET, a population-based US surveillance network across 13 states, provided nine influenza seasons of data on children under 18 admitted with laboratory-confirmed influenza. The analysis of ICU admission included 6,044 children, 70% of whom received oseltamivir; the median age was three and half had a chronic condition, most often asthma.

Treating oseltamivir as a time-dependent exposure — so that children were counted as treated only from the moment they received it — oseltamivir was associated with a lower hazard of ICU admission (adjusted HR 0.69, 95% CI 0.60 to 0.80) and quicker discharge (HR for discharge 1.13, 1.06 to 1.21).

Use of antivirals in admitted children has been falling, partly because of doubts about trial evidence. This is observational and cannot rule out every confounder, but its design addresses a common bias in earlier studies, and it supports current advice to start oseltamivir promptly in any child admitted with suspected or confirmed influenza, without waiting for test results.

• Start oseltamivir promptly in any child admitted with suspected or confirmed influenza
• Do not wait for a test result before treating an admitted child in influenza season
• Treat even if symptoms began more than 48 hours ago in a child sick enough to be admitted
• Prioritise children with asthma and other chronic conditions, who made up half of admissions
• Adjust the dose for age, weight and kidney function

Why it matters

Antiviral use in admitted children has been falling, and this suggests that costs some children an ICU bed.

Don't overread it

This was observational; residual confounding could account for part of the association.

The statistics, in plain English

A hazard ratio of 0.69 means treated children were admitted to ICU at about 31% lower rate at any given time. Counting treatment only from when it started avoids crediting the drug for time before it was given, a common error in older studies.

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