Speedy Antiviral Treatment Improves Outcomes for Kids with Flu

Children hospitalized with severe cases of flu were more likely to survive if they received antivirals within 48 hours of symptom onset than if they received the medications later, a new study finds.

Children hospitalized with severe flu symptoms are more likely to survive if they receive antiviral medication early in treatment, a new study finds.

Previous research has shown that adults treated with neuraminidase inhibitor drugs within the first 48 hours of flu symptom onset are less likely to be admitted to the intensive care unit or die than those who did not receive the drugs. However, evidence on the efficacy of the treatment in children is limited, and the inhibitors have been used less frequently to treat kids in recent flu seasons. To determine whether the drugs are beneficial to children, the current study, published online on November 25, 2013, in Pediatrics, analyzed the medical records of children hospitalized with severe cases of flu.

The researchers collected data from the California Department of Public Health on treatment and outcomes of children aged 17 and younger who had been admitted to intensive care units for laboratory-confirmed influenza during the H1N1 pandemic in 2009 and the following 2 flu seasons. Information on patients’ demographics, clinical presentation, comorbid conditions, and treatment were analyzed. Cases with influenza listed as the cause of death on the death certificate or medical record were considered fatal and were compared with nonfatal cases.

From April 3, 2009, to September 30, 2012, a total of 784 cases with treatment information were reported. During the H1N1 pandemic, 90% of children included in the study received neuraminidase inhibitors, compared with just 63% of those whose cases occurred after the pandemic. Of the 653 (83%) children treated with the drugs, 6% died, compared with 8% of untreated children. In addition, children who received early treatment were more likely to survive than those who received treatment later. Among children who received inhibitor drugs within the first 48 hours of symptom onset, just 3.5% died.

The results suggest that timely antiviral treatment may significantly reduce the risk for death in children with severe cases of flu. Nonetheless, more than one-third of children diagnosed with severe flu in the seasons following the pandemic did not receive the treatment. The authors of the study emphasize the importance of the treatment, but also note that more research on its safety is still needed.

“[P]rompt initiation of [neuraminidase inhibitors] seems prudent in a critical care setting where the likelihood of severe morbidity and mortality outweighs concern for side effects,” they write.