Treatment with oseltamivir in children hospitalized with community-acquired, laboratory-confirmed influenza: review of five seasons and evaluation of an electronic reminder.

TitleTreatment with oseltamivir in children hospitalized with community-acquired, laboratory-confirmed influenza: review of five seasons and evaluation of an electronic reminder.
Publication TypeJournal Article
Year of Publication2009
AuthorsWilkes JJ, Zaoutis TE, Keren R, Desai B, Leckerman KH, Hodinka RL, Metjian TA, Coffin SE
JournalJ Hosp Med
Volume4
Issue3
Pagination171-8
Date Published2009 Mar
ISSN1553-5606
KeywordsAdolescent, Antiviral Agents, Child, Child, Preschool, Cohort Studies, Community-Acquired Infections, Hospitals, Pediatric, Humans, Infant, Influenza, Human, Oseltamivir, Physician's Practice Patterns, Reminder Systems, Retrospective Studies
Abstract

BACKGROUND: When initiated within 48 hours of the onset of symptoms, oseltamivir has been shown to reduce severity and length of influenza illness. Few studies have evaluated the use of oseltamivir in patients hospitalized with influenza.

OBJECTIVE: To describe the prescribing practices for oseltamivir in children hospitalized with influenza and to evaluate a mechanism to improve the rate of appropriate prescription.

DESIGN, SETTING, PATIENTS: Retrospective cohort study of 929 patients aged 21 years or younger hospitalized with community-acquired laboratory-confirmed influenza (CA-LCI) during 5 consecutive seasons (2000-2005). We examined oseltamivir eligibility, which included patients 1 year of age or older with an influenza test result available within 48 hours of symptom onset. During the 2005-2006 season, an observational trial of an electronic reminder was conducted to improve the frequency of oseltamivir prescription.

MEASUREMENTS: Oseltamivir prescription.

RESULTS: Of 305 patients (32.8%) eligible for treatment with oseltamivir, 49 (16.1% of those eligible) were prescribed oseltamivir during hospitalization. Prescription rates for indications consistent with the US Food and Drug Administration (FDA) approval ("on label") increased from 0% to 37.2% over 5 seasons (P < 0.0001). Prescriptions outside this recommendation ("off label") also increased over 5 seasons (P < 0.0001). Twenty-nine (5%) of 624 patients were treated with oseltamivir off label; 11 were less than 1 year of age. Initiation of a reminder had no impact on prescription (P > 0.05).

CONCLUSIONS: Oseltamivir was used infrequently for children hospitalized with influenza. In addition, use inconsistent with the FDA label of oseltamivir occurs. Mechanisms are needed to improve appropriate prescription of oseltamivir.

DOI10.1002/jhm.431
Alternate JournalJ Hosp Med
PubMed ID19301375
Grant ListH23/CCH32253-02 / / PHS HHS / United States