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Outpatient Influenza Antiviral Use: We Can Do Better!

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We are all familiar with influenza and its complications in children, including younger children with underlying comorbidities. We should also be familiar with the benefits of providing antiviral prophylaxis and of treating children according to the recommendations from the American Academy of Pediatrics, the Infectious Disease Society of America, and the Centers for Disease Control and Prevention (CDC). These organizations all recommend consideration of antiviral treatment (eg, oseltamivir) for children diagnosed with presumptive or confirmed influenza within 48 hours of symptom onset. How consistent are we in prescribing antivirals to children with influenza?

Antoon et al. (10.1542/peds.2023-061960) evaluated ten years of prescription claims from a large national database of commercially insured individuals. From 2010 to 2019, there were about 1.4 million dispensings of oseltamivir, baloxavir, or zanamivir. The most common antiviral was oseltamivir (99.8%). Counter to expectations, prescription rates were higher in teens compared with infants and toddlers, who have a higher risk of influenza-related complications. Only 37% of eligible children with influenza less than 2 years of age and 34% of children 2-5 years of age with an influenza diagnosis filled a prescription for an antiviral agent. The authors note wide variability in use of antiviral agents for influenza by age, geographic region, presence of high-risk conditions, and across different influenza seasons.

Why are the rates of influenza treatment so low and variable, and what can we do? We invited Dr. Pia Pannaraj from University of California San Diego and Rady Children’s Hospital to share her thoughts in an accompanying commentary (10.1542/peds.2023-063481). Dr. Pannaraj offers a number of possible reasons and a call to action for us to increase our influenza vaccination rates and follow national recommendations for antiviral use. This study and commentary are nothing to sneeze at—so link to both and raise your awareness of how much more frequently you might remember to use antivirals when influenza is a lead possibility in the diagnosis of an upper respiratory illness.

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