Early antiviral treatment shortens hospitalization in kids with flu, comorbidities

Prompt empiric antiviral treatment in children hospitalized for influenza and with high-risk medical conditions or in children admitted to an intensive care unit (ICU) leads to early discharge, as shown in a study.

“[E]arly antiviral treatment, almost exclusively with oseltamivir [and] within 2 days of symptom onset, was associated with a shortened hospital length of stay [LOS] compared with no or later treatment. Among children with medical conditions [specifically], mean and median LOS was ∼1 day shorter in those treated within 2 days. Later treatment at ≥3 days after illness onset had no significant effect,” according to the investigators.

“Our data support CDC recommendations for early empiric therapy of those hospitalized with confirmed or suspected influenza without awaiting results of laboratory testing. However, the use of sensitive molecular diagnostic testing with rapid turnaround has been reported to improve the proportion who receive recommended early antiviral therapy, and molecular testing is recommended for all hospitalized patients with suspected influenza,” they added. [https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm; J Clin Virol 2019;110:11-16; Clin Infect Dis 2019;69:1243-1253; https://www.cdc.gov/flu/professionals/diagnosis/overview-testing-methods.htm]

The study included two cohorts of children hospitalized with laboratory-confirmed influenza in the US Influenza Hospitalization Surveillance Network. The first comprised children with underlying medical conditions not admitted to the ICU (n=309), and the second consisted of those in the ICU (including children with and without underlying conditions; n=299).

In the medical conditions cohort, antivirals were omitted in 73 (24 percent) children, started ≤2 days after symptom onset in 199 (64 percent), and started ≥3 days after symptom onset in 37 (12 percent). In the ICU cohort, antivirals were omitted, initiated early or late in 86 (29 percent), 168 (56 percent), and 45 (15 percent) children, respectively.

Multivariable Cox proportional hazard models showed that children who received antiviral treatment ≤2 days after illness onset were more likely to be discharged early than those who did not receive antiviral treatment. This was true in both the medical conditions and ICU cohorts, with early antiviral initiation associated with an increase of 37 percent (p=0.02) and 46 percent (p=0.007) in daily discharge probability, respectively. [Pediatrics 2021;148:e2021050417]

“Neuraminidase inhibitors (NAIs) were the recommended influenza antiviral drugs during the study period. Our findings are consistent with the few observational studies in which researchers have reported improved outcomes in children receiving early compared with later NAI treatment of influenza,” according to the investigators. [Pediatr Infect Dis J 2011;30:962-966; Pediatrics 2013;132:e1539-e1545]

Taken together, the findings indicate that early antiviral treatment is beneficial to hospitalized children with laboratory-confirmed influenza, they said. “Efforts should be directed to encourage families of children at higher risk for complications for influenza to seek care early in the course of influenza-like illness.” [https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm]