Editor’s Note: Elizabeth Zeichner (she/her) is a former high school teacher. She is a pediatrics resident at the Children’s Hospital of Philadelphia. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
In the 2024–2025 flu season (October 1–March 1), the Centers for Disease Control and Prevention (CDC) estimates there were 40-70 million flu illnesses and 520,000-1.1 million flu hospitalizations, with preliminary data showing high in-season flu severity across all ages. The American Academy of Pediatrics (AAP) and the CDC, along with other professional societies, recommend that all hospitalized children with influenza be treated with an anti-viral medication (typically the neuraminidase inhibitor, oseltamivir).
Despite these recommendations, it is unclear how often this happens in practice. This week, Pediatrics is early releasing the article “Variability of Clinician Recommendations for Oseltamivir in Children Hospitalized With Influenza,” by Hannah Bassett, MD, at Stanford University and hospital medicine and infectious disease colleagues from 7 other US pediatric institutions (10.1542/peds.2024-069111). The article, which has an accompanying video abstract, looks at clinician awareness of and adherence to influenza anti-viral medication guidelines in hospitalized children.
The authors administered a cross-sectional survey in March–June 2024 to pediatric clinicians (attending physicians, fellows, and advanced practice providers) in 5 pediatric specialties across 7 US pediatric institutions. The survey assessed participant knowledge of oseltamivir guidelines and incorporated four clinical vignettes of children hospitalized with influenza—all of whom meet AAP criteria to receive oseltamivir. The survey asked respondents to identify the likelihood that they would administer oseltamivir in each scenario. Interestingly, the 787 respondents recommended patients receive oseltamivir in only 49.5% of cases.
There was significant variability in responses, including variability based on each clinical vignette, specialty, and geographic location/institution of survey respondents. Clinicians were more likely to recommend oseltamivir for patients hospitalized with more severe symptoms (e.g., patients with co-morbid medical conditions or requiring respiratory support) and less likely to recommend if patients had a longer duration of symptoms. Consultants, such as pediatric infectious disease specialists, were more likely to recommend oseltamivir than pediatric hospital medicine providers. Of note, only one-third of all respondents correctly recommended that patients in each clinical vignette should receive oseltamivir.
The authors describe several factors contributing to variability in prescribing oseltamivir to pediatric patients hospitalized with influenza. For instance, there is general uncertainty surrounding current recommendations, and the authors note that there is a lack of high-quality data from hospitalized children with influenza to provide substantial evidence-based support of current guidelines. Existing data on oseltamivir also shows maximal benefit when treatment is initiated within 48 hours, so it is not surprising that study participants were less likely to recommend oseltamivir when patients had a longer duration of symptoms.
Based on this article, we have significant areas for growth when it comes to following current influenza anti-viral guidelines. However, there is also more work to be done in strengthening existing research on use of these medications, especially in hospitalized children with influenza.
