Clinician Preferences for Oseltamivir Use in Children With Influenza in the Outpatient Setting
Hannah K Bassett1, Suchitra Rao2, Jimmy Beck3
1Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
Insights
Pediatric clinicians frequently deviate from national guidelines for prescribing oseltamivir to children with influenza. Symptom duration significantly impacts treatment decisions, highlighting a need for standardized influenza management protocols.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Public Health
Background:
- National guidelines recommend antiviral treatment for high-risk children with influenza, irrespective of symptom duration.
- Outpatient antiviral prescribing practices for pediatric influenza remain inconsistent.
- Oseltamivir is a key antiviral medication for influenza treatment in children.
Purpose of the Study:
- To evaluate pediatric clinicians' outpatient prescribing practices for oseltamivir in children diagnosed with influenza.
- To identify factors influencing prescribing decisions, including symptom duration and clinical specialty.
Main Methods:
- A vignette-based survey study involving pediatric clinicians from 7 US children's hospitals and clinics.
- Participants reviewed 4 clinical vignettes depicting influenza scenarios, with one vignette randomized for symptom duration.
- The primary outcome measured was the likelihood of recommending oseltamivir based on vignette characteristics.
Main Results:
- A response rate of 40.2% (452/1124) was achieved, with no evidence of response bias.
- Clinicians were likely to recommend oseltamivir in only 36.2% of cases, showing significant variation by specialty (e.g., infectious diseases vs. emergency medicine).
- Increasing symptom duration from 2 to 4 days substantially decreased the likelihood of oseltamivir recommendation (30.9% to 1.8%).
Conclusions:
- Significant nonadherence to national influenza treatment guidelines was observed in outpatient pediatric settings.
- Variability in oseltamivir prescribing suggests uncertainty regarding its perceived benefit in non-severe pediatric influenza cases.
- Standardization of treatment protocols and outcome monitoring are crucial for improving influenza management in children.
Objective:
Professional societies recommend antiviral treatment of all children at high risk for severe or complicated influenza disease, regardless of symptom duration. However, outpatient antiviral prescribing practices are inconsistent. We aimed to assess pediatric clinicians' outpatient prescribing practices for oseltamivir in children with influenza.
Methods:
This vignette-based study of pediatric clinicians was conducted from March to June 2024 at 7 US children's hospitals and their affiliated clinics. The survey included 4 clinical influenza vignettes, 3 of which represented scenarios warranting treatment per national recommendations. One vignette was randomized to explore the impact of symptom duration on treatment preferences. Our primary outcome was the proportion of vignettes for which respondents were likely, somewhat or extremely, to recommend oseltamivir.
Results:
Of 1124 eligible participants, 452 (40.2%) responded to the survey. Successive wave analysis revealed no evidence of response bias. Participants were likely to recommend oseltamivir in 36.2% of cases, with variation among specialties (29.6% for emergency medicine, 37.2% for general pediatrics, and 48.6% for infectious diseases; P < .001) and among study sites from 28.6% to 50.7% (P = .018), adjusted for clustering. Longer symptom duration (2 vs 4 days) significantly decreased respondents' likelihood to recommend oseltamivir from 30.9% to 1.8% (P < .001).
Conclusions:
We demonstrate considerable nonadherence to national influenza treatment recommendations and variability regarding the outpatient use of oseltamivir to treat children with influenza. This indicates uncertainty of the perceived benefit of oseltamivir in a relatively healthy pediatric population with non-severe disease. Treatment standardization in accordance with national guidelines and rigorous monitoring of subsequent outcomes is needed.
Related Concept Videos
01:26Tonsillitis II: Management
01:16Drugs Used in Upper Respiratory Disorders: Overview
Antihistamines (e.g., Benadryl) block histamines from binding. Histamines are chemicals released during an allergic reaction in the body. As a...
01:30Acute Pharyngitis
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:15Upper Respiratory Drugs: First and Second-Generation Antihistamines
Histamine binds to specific receptor sites, known as H1 receptors, on tissue cells, triggering inflammation and swelling. Antihistamines combat these effects by competing with histamine for these receptor sites. By...
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include: