Assessment of Temporal Patterns and Patient Factors Associated With Oseltamivir Administration in Children
Patrick S Walsh1, David Schnadower2,3, Yin Zhang4
1Department of Pediatrics, Section of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee.
Insights
Oseltamivir use in hospitalized children with influenza increased significantly from 2007 to 2020, especially for high-risk patients. However, patient outcomes remained stable, indicating a need for further research on therapy effectiveness.
Area of Science:
- Pediatric Infectious Diseases
- Antiviral Therapy Research
- Healthcare Quality Improvement
Background:
- Oseltamivir is recommended for pediatric influenza hospitalizations, particularly for high-risk children.
- Limited data exist on oseltamivir uptake and its clinical benefits in this population.
Purpose of the Study:
- To analyze temporal trends and patient factors influencing oseltamivir use in hospitalized children with influenza.
- To examine changes in resource utilization and patient outcomes associated with oseltamivir therapy over time.
Main Methods:
- A multicenter retrospective cross-sectional study involving 70,473 pediatric influenza hospitalizations from 2007 to 2020.
- Utilized multivariable logistic regression to identify factors associated with oseltamivir use.
- Analyzed trends in resource use (antibiotics, radiography, ventilation) and patient outcomes (ICU transfer, readmission, mortality).
Main Results:
- Oseltamivir use increased from 20.2% to 77.9% during the study period, with significant institutional variation.
- Increased use was associated with complex chronic conditions, asthma, and severe illness; younger children had lower odds of use.
- While antibiotic and radiography use decreased, key patient outcomes like length of stay and mortality remained stable.
Conclusions:
- Oseltamivir utilization in pediatric influenza hospitalizations has risen, particularly for high-risk groups, but institutional disparities persist.
- Despite increased antiviral use, patient outcomes have not significantly improved, suggesting a need to re-evaluate treatment efficacy.
- Further research is warranted to understand the impact and optimize oseltamivir therapy for hospitalized children.
Importance:
Oseltamivir therapy is recommended for all pediatric inpatients with influenza, particularly those with high-risk conditions, although data regarding its uptake and benefits are limited.
Objective:
To describe temporal patterns and independent patient factors associated with the use of oseltamivir and explore patterns in resource use and patient outcomes among children hospitalized with influenza.
Design, Setting, And Participants:
This multicenter retrospective cross-sectional study was conducted at 36 tertiary pediatric hospitals participating in the Pediatric Health Information System in the US. A total of 70 473 children younger than 18 years who were hospitalized with influenza between October 1, 2007, and March 31, 2020, were included.
Exposures:
Hospitalization with a diagnosis of influenza.
Main Outcomes And Measures:
The primary outcome was the use of oseltamivir, which was described by influenza season and by hospital. Patient factors associated with oseltamivir use were assessed using multivariable mixed-effects logistic regression models. Secondary outcomes were resource use (including antibiotic medications, chest radiography, supplemental oxygen, positive pressure ventilation, central venous catheter, and intensive care unit [ICU]) and patient outcomes (length of stay, late ICU transfer, 7-day hospital readmission, use of extracorporeal membrane oxygenation, and in-hospital mortality), which were described as percentages per influenza season.
Results:
Among 70 473 children hospitalized with influenza, the median (IQR) age was 3.65 (1.05-8.26) years; 30 750 patients (43.6%) were female, and 39 715 (56.4%) were male. Overall, 16 559 patients (23.5%) were Black, 36 184 (51.3%) were White, 14 133 (20.1%) were of other races (including 694 American Indian or Alaska Native [1.0%], 2216 Asian [3.0%], 372 Native Hawaiian or Pacific Islander [0.5%], and 10 850 other races [15.4%]), and 3597 (5.1%) were of unknown race. A total of 47 071 patients (66.8%) received oseltamivir, increasing from a low of 20.2% in the 2007-2008 influenza season to a high of 77.9% in the 2017-2018 season. Use by hospital ranged from 43.2% to 79.7% over the entire study period and from 56.5% to 90.1% in final influenza season studied (2019-2020). Factors associated with increased oseltamivir use included the presence of a complex chronic condition (odds ratio [OR], 1.42; 95% CI, 1.36-1.47), a history of asthma (OR, 1.31; 95% CI, 1.23-1.38), and early severe illness (OR, 1.19; 95% CI, 1.13-1.25). Children younger than 2 years (OR, 0.81; 95% CI, 0.77-0.85) and children aged 2 to 5 years (OR, 0.83; 95% CI, 0.79-0.88) had lower odds of receiving oseltamivir. From the beginning (2007-2008) to the end (2019-2020) of the study period, the use of antibiotic medications (from 74.4% to 60.1%) and chest radiography (from 59.2% to 51.7%) decreased, whereas the use of oxygen (from 33.6% to 29.3%), positive pressure ventilation (from 10.8% to 7.9%), and central venous catheters (from 2.5% to 1.0%) did not meaningfully change. Patient outcomes, including length of stay (median [IQR], 3 [2-5] days for all seasons), readmissions within 7 days (from 4.0% to 3.4%), use of extracorporeal membrane oxygenation (from 0.5% to 0.5%), and in-hospital mortality (from 1.1% to 0.8%), were stable from the beginning to the end of the study period.
Conclusions And Relevance:
In this cross-sectional study of children hospitalized with influenza, the use of oseltamivir increased over time, particularly among patients with high-risk conditions, but with wide institutional variation. Patient outcomes remained largely unchanged. Further work is needed to evaluate the impact of oseltamivir therapy in this population.
