Antivirals May Help Kids Fight the Flu

Antiviral therapy like Tamiflu appeared effective for children hospitalized with influenza

(RxWiki News) One of the best ways to avoid the flu is to get the annual flu vaccine. Yet many children will still get the flu each year and possibly need hospitalization. Can antivirals help?

A recent study found that serious cases of children with the flu had slightly better survival rates if they received antiviral treatment.

The only children studied were those who were hospitalized in the intensive care unit with influenza.

Among these serious cases, more children receiving antiviral treatment survived compared to those not receiving antiviral treatment.

Parents should discuss with doctors what the treatment options are for children who are hospitalized with influenza.

"Talk to your child's pediatrician about the flu shot."

The study, led by Janice K. Louie, MD, MPH, of the California Department of Public Health, aimed to find out how effective neuraminidase inhibitors were in treating influenza in children.

There are currently three of these antiviral medications available:

The researchers examined the cases of 784 children (aged 17 or younger) who were hospitalized in the intensive care unit (ICU) for influenza between 2009 and 2012.

During the 2009 H1N1 pandemic, 90 percent of the 591 patients treated for the flu received neuraminidase inhibitors.

In the two years after the pandemic, 63 percent of 193 patients treated for the flu received neuraminidase inhibitors.

Among the 653 children who were treated with neuraminidase inhibitors, 6 percent (38 children) died, compared to 8 percent (11 children) of the 131 patients who did not receive the medication.

The researchers took this information and calculated in the influence of other factors that could have affected the children's survival, including use of artificial breathing.

After this calculation, the researchers determined that children treated with  neuraminidase inhibitors for the flu had about two thirds lower odds of dying than those not receiving the antivirals.

The earlier children received treatment with neuraminidase inhibitors, the less likely they were to die — especially if they received the treatment within the first two days of the illness.

"Our results suggest that prompt neuraminidase inhibitor therapy in children with influenza virus infection who are hospitalized in an ICU may improve survival, including in those most severely ill who require mechanical ventilation," the researchers wrote.

"These findings also emphasize the need for, and the difficulty in obtaining, better evidence of the efficacy and optimal timing of neuraminidase inhibitor therapy in children," they wrote.

Despite this need for more research, the researchers wrote that "prompt initiation of neuraminidase inhibitors seems prudent in a critical care setting where the likelihood of severe morbidity and mortality outweighs concern for side effects."

Chris Galloway, MD, a dailyRx expert who specializes in emergency medicine, said this study is a reminder that flu season can be a deadly time where early treatment might be life-saving.

"The very young and the very old are at the highest risk of complications from the flu, and antiviral medications specific to the flu can help when started early," he said.

"While the conclusions in this article did not reach statistical significance for mortality when started early, it does show a trend that these pediatric patients had better outcomes when flu antivirals were started within 48 hours of illness," Dr. Galloway said.

"Get vaccinated each year because herd (community) immunity is the best combatant to the spread of influenza," he added.

The study was published November 25 in the journal Pediatrics. The research was funded by the California Department of Public Health. The authors declared no conflicts of interest.

Review Date: 
November 24, 2013