Underused antivirals in pediatric influenza treatment

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In the almost 10 years of data collected by the research team, nearly 1.5 million antiviral medications were dispensed to pediatric patients, and oseltamivir accounted for 99.8% of those prescriptions.

Underused antivirals in pediatric influenza treatment | Image Credit: © Peter Hermes Furian - © Peter Hermes Furian - stock.adobe.com.

Underused antivirals in pediatric influenza treatment | Image Credit: © Peter Hermes Furian - © Peter Hermes Furian - stock.adobe.com.

Takeaways

  • Less than 60% of American children received the flu vaccine last year, contributing to increased influenza cases.
  • Antiviral medications, particularly oseltamivir, are underutilized in treating pediatric influenza cases, with varied prescribing patterns.
  • High-risk children aged 2 and under receive antivirals at less than 40%, highlighting age-related disparities in treatment adherence.
  • Complicated prescribing rules, limited medication options, and regional variations contribute to challenges in implementing consistent antiviral treatment.
  • The study underscores an opportunity for optimizing prescription and dispensing practices, emphasizing the need for further research, education, and guideline updates.

Vaccination is a highly effective tool in preventing cases of influenza, but less than 60% of American children received the flu vaccine last year, and compliance has decreased overall in recent years. When influenza infection does happen—with or without vaccination—antiviral treatments are not always the first choice for treating severe cases.1

Supportive care is the go-to for many viral infections like influenza, but data suggest that the use of antiviral medications can help reduce the duration and severity of illness in the pediatric population. What isn’t clear, according to a new study published in Pediatrics, is how often these medications are actually used to treat influenza in children.2

Researchers sought to answer this question by reviewing real-world prescribing data from outpatient and emergency medical clinics. Data collection focused on the prescribing of antiviral medications in pediatric patients under the age of 18 years, between 2010 and 2019.

The study tracked the dispensing of the following antiviral medications for influenza:

  • Oseltamivir
  • Baloxavir
  • Zanamivir

In the almost 10 years of data collected by the research team, nearly 1.5 million antiviral medications were dispensed to pediatric patients, and oseltamivir accounted for 99.8% of those prescriptions. The use of this medication was highest among children in the 12- to 17-year-old range during the 2017 to 2018 flu season, according to the report.

Research added that antiviral use for high-risk children aged 2 years and under—as suggested in guidelines—was low overall, at less than 40%.

The study concluded that, overall, antiviral medications for the treatment of influenza in children are underutilized, and that use of these medications is highly variable and not necessarily in line with treatment guidelines.

The reasons for this underuse can be complicated, according to the report. Although 10% of the pediatric population develops symptomatic influenza infection each year on average, another 30% have the flu with no symptoms. Additionally, national guidelines promote the use of antiviral medications in treating pediatric patients with the flu only within the first 48 hours of symptom onset, the research team notes.

There are limited options for antiviral treatment in children, too, since oseltamivir is the only approved oral medication to treat influenza in children aged 5 years and under. Other medications are given as inhaled or injected medications. Other antiviral medications like baloxavir and zanamivir have more specific prescribing requirements, such as specific age ranges or risk profiles, the report states.

Changes to prescribing rules and other guidelines for use have also muddied the waters for antiviral prescribing in children, the authors suggest. Despite widespread recommendations, the use of oseltamivir in children was as low as 15% in 2009, and there is a wide range of usage patterns across different geographical regions in the United States.

Finally, research suggests that only about 58% of children can truly be considered high risk when it comes to influenza infection and complications, so antiviral prescribing may be impacted by risk assessment as well as diagnosis timeframes. Approximately 70% to 80% of children hospitalized with influenza are given antivirals according to guidelines.

The study suggests that questions about the efficacy, availability, and cost of antiviral medications all play a role in prescribing patterns. The research team also points to a lack of more recent data on prescribing patterns—especially in the post-COVID era—as an obstacle for accurately assessing current antiviral use.

There is an opportunity to optimize prescription and dispensing practices once this data is collected, the study concludes, but current data makes it clear that antivirals are largely underused in the pediatric population.

Additional research, education, and possibly renewal of guideline recommendations are target areas to improve care when it comes to pediatric influenza infections, according to the report.

References:

  1. Flu vaccination coverage, United States, 2022–23 influenza season. CDC. October 2023. Accessed November 22, 2023.
    https://www.cdc.gov/flu/fluvaxview/coverage-2223estimates.htm#:~:text=In%20the%202022%E2%80%9323%20flu,the%20prior%20season%20(49.4%25)
  2. Antoon JW, Sarker J, Abdelaziz A, et al. Trends in outpatient influenza antiviral use among children and adolescents in the United States. Pediatrics. November 2023;e2023061960. doi:10.1542/peds.2023-061960/195295
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