In The News: Study Identifies Ways to Improve Antiviral Prescribing for Infants with Flu

Healio reports on a study published in the Journal of the Pediatric Infectious Diseases Society into antiviral prescribing for infants with flu. CDC recommends the antiviral oseltamivir for infants younger than two years of age with confirmed or suspected flu. Overall adherence was noted as high, though room for improvement existed. Study authors found providers weighed presence of a fever, time since symptom onset and test result delays as factors on which infants were prescribed oseltamivir.

The importance of treatment extends through health outcomes to time away from family. Infants who receive oseltamivir early in their illness experience shorter hospital stays and less risk of readmission or escalation to the ICU. Resulting less fever or symptoms translates to shorter absences from day care for the children and work for the parents. Two-thirds of infants in the study were eligible for the flu vaccine. Less than one-third, however, had received two doses at the time of diagnosis.

The retrospective cohort study included 457 infants younger than two years of age who tested positive for flu between January 2012 and July 2020. Prescriptions of oseltamivir were analyzed for the study with prescription rates based on time since onset, presence of fever, and type of flu test compared. Study authors found more than 80% of cases occurred between August 2016 and July 2020. This was attributed to “the acquisition of additional pediatric practices into our health system and increased alignment of EHRs during this time, as well as increased availability and utilization of [rapid influenza diagnostic tests (RIDT)] within outpatient and urgent care settings across our health system beginning in 2018.”

Researchers found infants were less likely to receive oseltamivir if they did not have a fever at the time of diagnosis or if they had symptoms for more than 2 days. The recommendation states oseltamivir be given within 48 hours of flu symptom onset. In total, infants with flu received a prescription 85.7% of cases, with improvements on the rate throughout the study period. This suggested to researchers a gradual adherence to the CDC guidelines.

Study author and PIDS member, Anne-Marie Rick, is quoted in the article. “When given early in the course of illness, oseltamivir reduces the length of stay in hospitalized children, their risk for readmission and escalation of care, such as need for the ICU…It is important for pediatric clinicians to recognize that all children less than 2 years of age, regardless of any underlying medical conditions, are considered high risk for the complications of influenza, and so prescription of oseltamivir is appropriate when influenza infection is confirmed or suspected regardless of when symptoms started.”