Oseltamivir safely reduces disease duration in kids with influenza

Last Updated: 2017-12-08

By Will Boggs MD

NEW YORK (Reuters Health) - Oseltamivir is safe and effective for treating children with influenza, according to a systematic review.

"Oseltamivir should be used in treating children who have more severe manifestation of influenza," said Dr. Arnold S. Monto from the University of Michigan School of Public Health in Ann Arbor.

"It is effective, especially when given early and because of potential severity. It has been studied and is approved in children down to 2 weeks of age," he told Reuters Health by email.

Oseltamivir has been shown to be safe and effective in adults with influenza, but some have expressed safety concerns regarding its use in children.

Following a systematic review of the literature, Dr. Monto's team undertook a meta-analysis of five randomized controlled trials (2,561 participants, 1,598 with laboratory-confirmed influenza infection) to estimate the efficacy of timely oseltamivir treatment for uncomplicated influenza in children <18 years old in the outpatient setting, compared with placebo.

Oseltamivir treatment reduced the duration of illness by a mean 17.6 hours among patients with confirmed infection and by a mean 8.4 hours in the overall population, compared with placebo.

In trials that enrolled only children with asthma, there was no significant effect of oseltamivir treatment in reducing disease duration, according to the November 23 online report in Clinical Infectious Diseases.

Among children with confirmed infection, oseltamivir treatment was associated with a significant 34% reduction in the risk of developing otitis media, but no significant reduction in lower-respiratory-tract complications.

Children treated with oseltamivir were 63% more likely to experience vomiting, but there was no evidence of significantly increased risks of nausea, diarrhea, or severe adverse events, compared with children treated with placebo.

In pooled analyses, duration of illness was reduced to a greater extent among children who received treatment within 24 hours of symptom development than among those who received treatment 24 to 48 hours after onset, and the largest reduction in duration of illness was seen among adolescents (ages 12-17).

"The antiviral effects of oseltamivir are present, but they are modest," Dr. Monto said. "It is a useful drug and is currently the only one generally available. There is a clear need for a more effective drug, but oseltamivir should be used as appropriate until a new one is developed."

Dr. Flor M. Munoz from Baylor College of Medicine and Texas Children's Hospital, in Houston, who contributed to the formulation of the American Academy of Pediatrics (AAP) recommendations for prevention and control of influenza in children, told Reuters Health by email, "Current Centers for Disease Control and Prevention (CDC) and AAP treatment recommendations are supported by the studies reviewed in this meta-analysis. It is important to note that these effects are most evident in children who are otherwise healthy (no asthma), who often are not offered treatment; however, just by virtue of age (<5 years), children are at higher risk for complications of influenza."

"I believe that the beneficial effects reported in this study are very important, not just for the individual child/patient who will be better faster when treated (in this case, practically with complete resolution of symptoms, based on the definitions used), but for everyone around them, including the parents who have to care for the child and miss work," she said.

"Children not only improve faster clinically, but they are able to resume their usual activities promptly - this is critical for students, athletes, children in music bands, art programs, and any activity that requires their presence and participation," Dr. Munoz added.

These results "provide reassurance for most practitioners who might be confused with 'controversies' being raised by some who are not convinced of the efficacy of neuraminidase inhibitors," she said.

The new analysis was funded by the Multiparty Group for Advice on Science Foundation through an unrestricted grant from Roche Pharmaceuticals. "Neither party had a role in analysis, interpretation, reporting or the decision to submit for publication," the authors note.

Dr. Monto reported receiving consulting fees from Roche related to the new work.

SOURCE: http://bit.ly/2iEH35N

Clin Infect Dis 2017.