Background: The US Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend that children hospitalized with influenza receive an antiviral medication. This is especially important for children with comorbid conditions associated with a higher risk of influenza complications. Despite this, previous studies have shown that influenza antivirals are underused. The objectives of this study are to (1) characterize antiviral use patterns among hospitalized children with influenza including those with high risk conditions and (2) quantify the variability in antiviral prescribing across a network of children's hospitals.
Methods: We conducted a retrospective cohort study of children <18 years hospitalized at 44 freestanding children's hospitals during the 2009 pandemic season (April 1st-September 30th) and the 2009-2010 through 2013-2014 influenza seasons (October 1st-May 15th). The proportion of children with an influenza ICD9 diagnosis code (487.x, 488.x) who received an influenza antiviral (oseltamivir, zanamivir, or peramivir) was calculated. Regression models were constructed to test whether influenza antiviral prescribing differed between children with and without high risk conditions.
Results: There were 29,802 inpatient admissions with an influenza diagnosis code, of which 69% (range: 40-82%) had an antiviral prescribed (Figure). The proportion of children that received an antiviral across all hospitals ranged from a minimum of 58% in 2011-2012 to a maximum of 75% in 2013-2014. Children with high risk conditions were not more likely to receive an influenza antiviral than those without a high risk condition (70% vs. 69%; P=0.08). During 2013-2014, antiviral use across hospitals ranged from 22% to 91%. In 50% of hospitals, influenza antivirals were prescribed to <70% of children diagnosed with influenza who had high risk conditions.
Conclusion: Antiviral prescribing for hospitalized children with influenza varied significantly by hospital and appears to be sub-optimal. Prompt use of antivirals for hospitalized children with influenza, especially those with high risk conditions, could maximize the potential benefits.
A. Pavia, None
K. Ampofo, None
J. Wilkes, None
E. K. Korgenski, None
A. L. Hersh, Pfizer: Grant Investigator , Grant recipient and Research grant