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Treatment with oseltamivir in children hospitalized with community‐acquired, laboratory‐confirmed influenza: Review of five seasons and evaluation of an electronic reminder
Author(s) -
Wilkes Jennifer J.,
Zaoutis Theoklis E.,
Keren Ron,
Desai Bimal,
Leckerman Kateri H.,
Hodinka Richard L.,
Metjian Talene A.,
Coffin Susan E.
Publication year - 2009
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.431
Subject(s) - oseltamivir , medicine , medical prescription , pediatrics , observational study , retrospective cohort study , emergency medicine , pharmacology , covid-19 , disease , infectious disease (medical specialty)
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. Journal of Hospital Medicine 2009;4:171–178. © 2009 Society of Hospital Medicine.