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Early use of oseltamivir (Tamiflu) in children hospitalized with influenza was associated with better outcomes, according to a multicenter propensity score-weighted analysis.

Among over 55,000 children, treatment with oseltamivir upon arrival or on day 1 was linked with a shorter length of stay compared with treatment on day 2 or later or not at all (median 3 vs 4 days; inverse probability treatment weighting model ratio 0.52, 95% CI 0.52-0.53), reported Patrick S. Walsh, MD, MS, of the Medical College of Wisconsin in Milwaukee, and colleagues.

Early treatment was also associated with lower odds of readmission within 7 days (3.5% vs 4.8%, adjusted OR 0.72, 95% CI 0.66-0.77), late transfer to the intensive care unit (ICU; 2.4% vs 5.5%, aOR 0.41, 95% CI 0.37-0.46), and the composite outcome of death or extracorporeal membrane oxygenation (ECMO) use (0.9% vs 1.4%, aOR 0.63, 95% CI 0.54-0.73), they noted in .

"Our data support the current recommendations by the American Academy of Pediatrics and Infectious Diseases Society of America for oseltamivir use early in influenza disease course for hospitalized children," Walsh and team wrote.

A pandemic showed a benefit with neuraminidase inhibitors in adults, but not in children, they explained. What's more, previous observational studies "have been identified as having a high risk of bias."

This may explain why 33% of children in the current cohort were not given oseltamivir at all during hospitalization, and only 7% were treated later in their hospitalization, they said.

In sensitivity analyses comparing any oseltamivir versus no oseltamivir, the drug was associated with shorter length of stay and lower odds of 7-day readmission in those treated with late oseltamivir, but there was no association with late ICU transfers or death or ECMO use.

"What our findings may add to this literature is that the reduction in length of illness seems to apply to severe illness in addition to mild illness and is independent of where care is delivered," Walsh and team noted. "In fact, the group with the largest reduction in [length of stay] in our study were the patients initially admitted to the ICU."

Of note, while patients with asthma had a statistically different but not clinically meaningful change in length of stay (median 3 days for both groups), "this may reflect that patients with a history of asthma are more likely to be hospitalized with an asthma exacerbation triggered by influenza, resulting in a more predictable and abbreviated course, as opposed to other non-wheeze etiology for severe illness or respiratory failure," they explained.

For this retrospective analysis, Walsh and team included 55,799 children hospitalized from October 2007 through March 2020 across 36 tertiary care pediatric hospitals who participate in the Pediatric Health Information System database. Median patient age was 3.61 years, and 56% were boys. Nearly 60% received early oseltamivir, while 7% were given oseltamivir on day 2 or later of their hospital stay.

Compared with kids not treated with early oseltamivir, those who were treated early were more likely to be older (44.5% vs 38% age >5 years), have a complex chronic condition (48.1% vs 46.8%), and require early ICU admission (28.9% vs 24%).

In total, 2,241 children were readmitted to the hospital within 7 days, 1,486 required ICU care, 465 died, and 199 received ECMO.

Walsh and colleagues noted that while ICD codes are often reliable, they could not confirm that all included patients had laboratory-confirmed influenza, which was a limitation to their analysis.

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