Variability of Clinician Recommendations for Oseltamivir in Children Hospitalized With Influenza
Hannah K Bassett1, Suchitra Rao2, Jimmy Beck3
1Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
Insights
Pediatricians often do not follow national guidelines for prescribing oseltamivir to hospitalized children with influenza. A randomized controlled trial is needed to clarify treatment benefits for pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Public Health Policy
Background:
- National guidelines recommend antivirals for all hospitalized children with influenza.
- Evidence supporting these recommendations, such as randomized clinical trials, is limited.
- Recent data indicate potential nonadherence to current influenza treatment guidelines.
Purpose of the Study:
- To describe the treatment preferences of clinicians regarding oseltamivir for hospitalized children.
- To assess adherence to national recommendations for influenza treatment in pediatric inpatients.
Main Methods:
- A cross-sectional survey was conducted among pediatricians across 5 specialties at 7 US children's hospitals.
- Four clinical vignettes aligned with 2023 American Academy of Pediatrics (AAP) criteria were used.
- The primary outcome measured was the average proportion of vignettes where oseltamivir was recommended.
Main Results:
- A response rate of 42.7% (787/1841) was achieved.
- Oseltamivir was recommended for 49.5% of cases, with significant variation by hospital site and medical specialty.
- Factors decreasing recommendation likelihood included longer symptom duration and less oxygen support; AAP recommendation awareness increased likelihood but did not ensure adherence.
Conclusions:
- Significant nonadherence to national influenza treatment guidelines and variability in oseltamivir prescribing exist among clinicians for hospitalized children.
- Uncertainty and disagreement persist regarding optimal antiviral use in specific pediatric populations.
- A randomized controlled trial of oseltamivir in hospitalized children is crucial to strengthen evidence-based treatment recommendations.
Background And Objectives:
Although national recommendations advise antivirals for all hospitalized children with influenza, this recommendation is not supported by high-quality evidence like a randomized clinical trial, and recent data suggest nonadherence to guidelines. Our objective was to describe clinician treatment preferences for oseltamivir in hospitalized children.
Methods:
This cross-sectional survey of pediatricians from 5 specialties was conducted at 7 US children's hospitals from March to June 2024. Four clinical vignettes meeting 2023 American Academy of Pediatrics (AAP) criteria for antiviral treatment were included. Our primary outcome was the average proportion of vignettes for which respondents recommended oseltamivir.
Results:
Of 1841 invited participants, 787 (42.7%) completed surveys. Participants were likely to recommend oseltamivir for 49.5% (95% CI, 47.0%-51.9%) of cases; this varied by site from 43.5% to 64.2% and by specialty from 41.6% (hospital medicine) to 70.9% (infectious disease). Longer duration of symptoms and less oxygen support significantly decreased the likelihood of recommending oseltamivir. Awareness of AAP recommendations increased the likelihood of recommending treatment, although aware respondents did not recommend treatment in 38% of cases. Most respondents (87.4%) believed a randomized trial of oseltamivir in hospitalized children was moderately to extremely important.
Conclusions:
Our results demonstrate nonadherence to national recommendations and variability in oseltamivir treatment for children hospitalized with influenza, indicating uncertainty and disagreement regarding which patients benefit from antivirals. A randomized controlled trial of oseltamivir in hospitalized children is needed to help strengthen current influenza treatment recommendations and inform clinicians of treatment benefit in specific pediatric populations.
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