Variability of Clinician Recommendations for Oseltamivir in Children Hospitalized With Influenza.

Abstract

BACKGROUND AND OBJECTIVES Although national recommendations advise antivirals for all hospitalized children with influenza, this recommendation is not supported by high-quality evidence like a randomized clinical trial, and recent data suggest nonadherence to guidelines. Our objective was to describe clinician treatment preferences for oseltamivir in hospitalized children. METHODS This cross-sectional survey of pediatricians from 5 specialties was conducted at 7 US children's hospitals from March to June 2024. Four clinical vignettes meeting 2023 American Academy of Pediatrics (AAP) criteria for antiviral treatment were included. Our primary outcome was the average proportion of vignettes for which respondents recommended oseltamivir. RESULTS Of 1841 invited participants, 787 (42.7%) completed surveys. Participants were likely to recommend oseltamivir for 49.5% (95% CI, 47.0%-51.9%) of cases; this varied by site from 43.5% to 64.2% and by specialty from 41.6% (hospital medicine) to 70.9% (infectious disease). Longer duration of symptoms and less oxygen support significantly decreased the likelihood of recommending oseltamivir. Awareness of AAP recommendations increased the likelihood of recommending treatment, although aware respondents did not recommend treatment in 38% of cases. Most respondents (87.4%) believed a randomized trial of oseltamivir in hospitalized children was moderately to extremely important. CONCLUSIONS Our results demonstrate nonadherence to national recommendations and variability in oseltamivir treatment for children hospitalized with influenza, indicating uncertainty and disagreement regarding which patients benefit from antivirals. A randomized controlled trial of oseltamivir in hospitalized children is needed to help strengthen current influenza treatment recommendations and inform clinicians of treatment benefit in specific pediatric populations.