Oseltamivir Treatment for Influenza in Hospitalized Children Without Underlying Diseases

Bueno, Mercedes; Calvo, Cristina; Méndez-Echevarría, Ana; José, María Isabel de; Santos, Mar; Carrasco, Jaime; Tovizi, Miriann; Guillén, Sara; Blas, Andrés de; Llorente, Marta; Tarrago, Alfredo; Escosa, Luis; Cilleruelo, María José; Tomatis, C; Blázquez, Daniel; Otheo, Enrique; Mazagatos, Diana; García-García, Maria Luz

doi:10.1097/inf.0b013e31829be4bc

Cited by 21 publications

(18 citation statements)

References 28 publications

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“…All the studies in our systematic review included broad populations, and so subset data on people with cardio‐pulmonary conditions were extracted according to our predetermined inclusion criteria. The subset data from three studies were from patients with asthma, 11,26,27 and two were from those with cardio‐pulmonary conditions 25,28,29 . Two studies defined their high‐risk population as those with chronic cardio‐pulmonary conditions and/or the elderly and as individual data were not available, the whole population was included 30,31 .…”

Section: Resultsmentioning

confidence: 99%

Rate of use and effectiveness of oseltamivir in the treatment of influenza illness in high‐risk populations: A systematic review and meta‐analysis

Shim

Chan

Owens

et al. 2021

Health Science Reports

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Background Oseltamivir is recommended in the treatment of influenza illness in high‐risk populations, including those with chronic heart and lung diseases. Objectives We conducted a systematic review and meta‐analysis to determine the rate of use and effectiveness of oseltamivir in these groups of patients. Methods The protocol for the systematic review was registered on PROSPERO (CRD42019125998). Medline, EMBASE, Cochrane CENTRAL, and CINAHL were searched for observational studies and randomized controlled trials published up to 16 February 2020. Quality appraisal of final studies was conducted using GRADE guidelines. Data were extracted using a predeveloped template. Main outcomes measured included the rate of use of oseltamivir for influenza‐like‐illness and its effectiveness in reducing disease severity in patients with cardiopulmonary diseases. Outcomes measured for effectiveness were influenza‐related complications (respiratory infections and asthma exacerbations), hospitalization rates, and time to freedom from illness. Risk of bias was assessed using Cochrane's Risk of Bias 2.0 tool for randomized trials and Cochrane's Risk of Bias in nonrandomized Studies of Interventions tool for nonrandomized trials. Where data were available, pooled analyses were conducted. Dichotomous variables were evaluated using the Mantel‐Hansel method. A random effect model was applied. Summary measures were reported as risk ratios where relevant. Results Our systematic review identified nine studies. Oseltamivir use ranged from 25% to 100%. When oseltamivir group was compared to placebo, rates of respiratory tract infections reduced by 28% (RR = 0.72, 95% CI = 0.59‐0.90), hospitalization reduced by 52% (RR = 0.48, 95% CI = 0.28‐0.80) and median time to illness alleviation decreased by 10.4 to 120 hours. There was no significant reduction in asthma exacerbation rates. Conclusions Our systematic review suggests that the use of oseltamivir is beneficial in reducing disease severity, however, its use in high‐risk population remains suboptimal.

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Section: Resultsmentioning

confidence: 99%

Rate of use and effectiveness of oseltamivir in the treatment of influenza illness in high‐risk populations: A systematic review and meta‐analysis

Shim

Chan

Owens

et al. 2021

Health Science Reports

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“…23,24 A study of 287 hospitalized, previously healthy children found no difference in length of stay, diagnosis of pneumonia, ICU admission or death in NAItreated compared with untreated patients; however, the young age of patients (40% aged ,6 months) may have prompted hospitalization for observation purposes rather than because of severity of illness. 25 A retrospective cohort study of .500 children with severe seasonal influenza illness admitted to PICUs over 6 influenza seasons (2001)(2002)(2003)(2004)(2005)(2006)(2007) found that patients treated with oseltamivir within 24 hours of hospital admission had an 18% reduction in total hospital days (P = .02) but no significant reduction in length of PICU stay, in-hospital mortality, and readmission rates. 26 In contrast, a handful of small studies have suggested that early NAI treatment improves survival.…”

Section: Discussionmentioning

confidence: 99%

Neuraminidase Inhibitors for Critically Ill Children With Influenza

et al. 2013

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OBJECTIVE: Timely treatment with neuraminidase inhibitor (NAI) drugs appears to improve survival in adults hospitalized with influenza. We analyzed California surveillance data to determine whether NAI treatment improves survival in critically ill children with influenza. METHODS: We analyzed data abstracted from medical records to characterize the outcomes of patients aged 0 to 17 years hospitalized in ICUs with laboratory-confirmed influenza from April 3, 2009, through September 30, 2012. RESULTS: Seven hundred eighty-four influenza cases aged <18 years hospitalized in ICUs had information on treatment. Ninety percent (532 of 591) of cases during the 2009 H1N1 pandemic (April 3, 2009–August 31, 2010) received NAI treatment compared with 63% (121 of 193) of cases in the postpandemic period (September 1, 2010–September 30, 2012; P < .0001). Of 653 cases NAI-treated, 38 (6%) died compared with 11 (8%) of 131 untreated cases (odds ratio = 0.67, 95% confidence interval: 0.34–1.36). In a multivariate model that included receipt of mechanical ventilation and other factors associated with disease severity, the estimated risk of death was reduced in NAI-treated cases (odds ratio 0.36, 95% confidence interval: 0.16–0.83). Treatment within 48 hours of illness onset was significantly associated with survival (P = .04). Cases with NAI treatment initiated earlier in illness were less likely to die. CONCLUSIONS: Prompt treatment with NAIs may improve survival of children critically ill with influenza. Recent decreased frequency of NAI treatment of influenza may be placing untreated critically ill children at an increased risk of death.

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“…Retrospectively, there were no proven benefits for oseltamivir in hospitalized pediatric patients without underlying diseases or risk factors for developing a serious illness, including those with asthma [70]. Also the Cochrane meta-analysis, mainly based on 1 poorly designed study, described no significant benefit for oseltamivir treatment in children with pneumonia, although it might reduce the symptoms earlier, without other clinical relevance [71].…”

Section: Oseltamivirmentioning

confidence: 99%

Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

Tramper-Stranders

2018

Paediatric Respiratory Reviews

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Community acquired pneumonia (CAP) is a leading cause of childhood morbidity worldwide. Because of the rising antimicrobial resistance rates and adverse effects of childhood antibiotic use on the developing microbiome, rational prescribing of antibiotics for CAP is important. This review summarizes and critically reflects on the available evidence for the epidemiology, etiology and antimicrobial management of childhood CAP. Larger prospective studies on antimicrobial management derive mostly from low- or middle-income countries as they have the highest burden of CAP. Optimal antimicrobial management depends on the etiology, age, local vaccination policies and resistance patterns. As long as non-rapid surrogate markers are used to distinguish viral- from bacterial pneumonia, the management is probably suboptimal. For a young child with signs of non-severe pneumonia (with or without wheezing), watchful waiting is recommended because of probable viral etiology. For children with more severe CAP with fever, a five-day oral amoxicillin course would be the first choice therapy and dosage will depend on local resistance rates. There is no clear evidence yet for superiority of a macrolide-based regimen for all ages. For cases with CAP requiring hospitalization, several studies have shown that narrow-spectrum IV beta-lactam therapy is as effective as a broad-spectrum cephalosporin therapy. For most severe disease, broad-spectrum therapy with or without a macrolide is suggested. In case of empyema, rapid IV-to-oral switch seems to be equivalent to prolonged IV treatment.

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Oseltamivir Treatment for Influenza in Hospitalized Children Without Underlying Diseases

Abstract: There were no proven benefits of treatment with oseltamivir in hospitalized pediatric patients without the underlying diseases or risk factors for developing a serious illness, including those with asthma.

Cited by 21 publications

References 28 publications

Rate of use and effectiveness of oseltamivir in the treatment of influenza illness in high‐risk populations: A systematic review and meta‐analysis

Rate of use and effectiveness of oseltamivir in the treatment of influenza illness in high‐risk populations: A systematic review and meta‐analysis

Neuraminidase Inhibitors for Critically Ill Children With Influenza

Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

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