Factors Associated With Nonprescription of Oseltamivir for Infant Influenza Over 9 Seasons
Haniah A Zaheer1,2, Krissy Moehling Geffel3, Sarah Chamseddine2
1Department of Ophthalmology, UPMC Eye Institute, Pittsburgh, Pennsylvania, USA.
Insights
Oseltamivir prescribing for infants with influenza increased significantly over time, with most receiving the antiviral. Targeted provider education can further improve adherence to treatment guidelines for high-risk infants.
Area of Science:
- Pediatric Infectious Diseases
- Antiviral Therapeutics
- Public Health Surveillance
Background:
- Infants under 2 years are at high risk for influenza complications per CDC guidelines.
- Oseltamivir phosphate is recommended for confirmed or suspected influenza in this age group.
- Analysis of infant characteristics associated with oseltamivir nonprescription was conducted over 9 years.
Purpose of the Study:
- To analyze infant characteristics associated with oseltamivir nonprescription.
- To evaluate trends in oseltamivir prescribing for infants with confirmed influenza.
- To identify factors influencing antiviral treatment adherence in high-risk infants.
Main Methods:
- Retrospective electronic health record (EHR) review of infants <12 months old (2012-2019).
- Inclusion criteria: confirmed positive influenza test and >2 well-child visits.
- Multivariable logistic regression used to assess factors associated with oseltamivir nonprescription.
Main Results:
- 86% of 457 infants with confirmed influenza received oseltamivir.
- Prescribing increased from 64.6% (2012-2016) to 90.4% (2016-2020).
- Nonprescription associated with >2 days of symptoms, earlier diagnosis period, specific PCR tests, and absence of fever.
Conclusions:
- Adherence to CDC influenza antiviral treatment guidelines for infants is high and improving.
- Further improvements in oseltamivir prescribing may be achieved through targeted provider education.
- Ensuring optimal antiviral use in high-risk infants remains a public health priority.
Background:
The Centers for Disease Control and Prevention (CDC) recommends oseltamivir phosphate for children <2 years old with confirmed or suspected influenza as they are at high risk for complications. We analyzed infant characteristics associated with nonprescription of oseltamivir over 9 years.
Methods:
We conducted a retrospective electronic health record (EHR) review of infants <12 months old born between January 1, 2012 and December 31, 2019 within the University of Pittsburgh Medical Center health system in Southwestern Pennsylvania who had >2 well-child visits during their first year. Infants with a confirmed positive test for influenza were included in the analysis. Factors associated with infant oseltamivir nonprescription were assessed using multivariable logistic regression.
Results:
Of 457 infants with confirmed influenza, 86% were prescribed oseltamivir. The proportion of infants prescribed oseltamivir increased from an average of 64.6% during the 2012-2016 influenza seasons to 90.4% during the 2016-2020 influenza seasons. Infants were more likely to not be prescribed oseltamivir if they experienced >2 days of influenza symptoms (odds ratio (OR): 9.4, 95% CI: 4.8, 18.7, P < .001), were diagnosed during the 2012-2016 influenza seasons (OR: 4.2, 95% CI: 1.8, 9.5, P < .001), tested positive for influenza via a multiplex/reverse transcriptase polymerase chain reaction test (OR: 6.7, 95% CI: 2.7, 16.3, P < .001; OR: 2.7, 95% CI: 1.1, 7.1; P = .04), or did not have a fever at point-of-care (OR: 2.3, 95% CI: 1.2, 4.6, P = .01).
Conclusion:
Adherence to CDC influenza antiviral treatment guidelines for infants is high and improved over time. However, the provision of targeted education to providers may further improve oseltamivir prescribing practices for high-risk children <12 months of age.
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