Evidence Supports Early Oseltamivir Treatment for Pediatric Inpatients With Influenza

Early treatment with oseltamivir reduced the length of hospitalization in children with influenza, supporting current recommendations for oseltamivir use in this population.

Early oseltamivir administration reduces the length of hospitalization and risk for hospital readmission in children with influenza, according to study findings published in JAMA Pediatrics.

The American Academy of Pediatrics and Infectious Diseases Society of America both strongly recommend the use of oseltamivir for children hospitalized with influenza as it has been shown to hasten symptom reduction by a median time of 29 hours.

Researchers conducted a multicenter, retrospective cohort study among children hospitalized with influenza at 36 tertiary care pediatric hospitals between October 2007 and March 2020. The researchers aimed to evaluate the effects of early treatment with oseltamivir, defined as receipt of oseltamivir on hospital days 0 or 1. The primary outcome was length of hospitalization; secondary outcomes included readmission within 7 days, intensive care unit (ICU) transfer at day hospital 2 of later, and a composite outcome of in-hospital mortality or need for extracorporeal membrane oxygenation (ECMO).

Outcomes among patients who did and did not receive early oseltamivir treatment were compared using multivariable generalized linear mixed-effects models, with adjustments for demographic characteristics, comorbidities, and illness severity. Confounding by indication was addressed via inverse probability treatment weighting (IPTW) based on propensity scoring.

Among 55,799 patients included in the analysis, the median age was 3.61 (IQR, 1.03-8.27) years and 56% were boys, and 33,207 (59.5%) received early treatment with oseltamivir. Of 22,592 patients who did not receive early oseltamivir treatment, 7% received olsetamivir on or after hospital day 2, and 33% never received oseltamivir.

In the IPTW analysis, patients who did vs did not receive early oseltamivir had a shorter length of hospitalization (median, 3 vs 4 days; IPTW model ratio, 0.52; 95% CI, 0.52-0.53) and a lower rate of readmissions within 7 days (3.5% vs 4.8%; adjusted odds ratio [aOR], 0.72; 95% CI, 0.66-077). In addition, patients who did vs did not receive early oseltamivir were less likely to require ICU transfer at hospital day 2 or later (2.4% vs 5.5%; aOR, 0.41; 95% CI, 0.36-0.46) and had a lower rate of in-hospital mortality and ECMO use (0.9% vs 1.4%; aOR, 0.63; 95% CI, 0.54-0.73).

Our findings support the current recommendations for oseltamivir use in children hospitalized with influenza

The mixed-effects models and IPTW-adjusted analysis showed similar results.

Further analysis showed that patients who did vs did not receive early oseltamivir were more likely to be older than 5 years (44.5% vs 38%), have a complex chronic condition (48.1% vs 46.8%), and require early admission to the ICU (28.9% vs 24.0%).

Limitations include the inability to determine whether all patients had laboratory-confirmed influenza and the lack of clinical information, including illness history, physical examination findings, and laboratory test results. In addition, some patients classified as having never received oseltamivir may have received oseltamivir as outpatients prior to enrollment.

“Our findings support the current recommendations for oseltamivir use in children hospitalized with influenza,” the researchers concluded.


Walsh PS, Schnadower D, Zhang Y, Ramgopal S, Shah SS, Wilson PM. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. JAMA Pediatr. Published online September 19, 2022. doi:10.1001/jamapediatrics.2022.3261