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Oseltamivir Shortens Hospital Stays of Critically Ill Children Hospitalized With Seasonal Influenza: A Retrospective Cohort Study

Coffin, Susan E. MD, MPH*†‡; Leckerman, Kateri MS*; Keren, Ron MD, MPH†‡§; Hall, Matthew PhD; Localio, Russell PhD; Zaoutis, Theoklis E. MD, MSCE*†‡

The Pediatric Infectious Disease Journal: November 2011 - Volume 30 - Issue 11 - p 962-966
doi: 10.1097/INF.0b013e318232ede9
Original Studies

Background: Antiviral therapy reduces symptom duration and hospitalization risk among previously healthy and chronically ill children infected with seasonal influenza. The effect of oseltamivir on outcomes of hospitalized children is unknown. The primary objective of this study was to determine whether oseltamivir improves outcomes of critically ill children hospitalized with influenza.

Methods: We performed a retrospective cohort study of children with influenza infection admitted to a pediatric intensive care unit during 6 consecutive winter seasons (2001–2007). We used the Pediatric Health Information System database, which contains resource utilization data from 41 children's hospitals. We matched oseltamivir-treated patients with oseltamivir-nontreated patients by the probability of oseltamivir exposure using a propensity score we derived from patient and hospital characteristics. We subsequently compared the outcomes of critically ill children treated with oseltamivir within 24 hours of admission with propensity score matched children who were not treated with oseltamivir.

Results: We identified 1257 children with influenza infection, 264 of whom were treated with oseltamivir within 24 hours of hospital admission. Multivariable analysis of 252 oseltamivir-treated patients and 252 propensity score-matched untreated patients demonstrated that patients treated with oseltamivir experienced an 18% reduction in total hospital days (time ratio: 0.82, P = 0.02), whereas intensive care unit stay, in-hospital mortality, and readmission rates did not differ.

Conclusion: For critically ill children infected with seasonal influenza, treatment with oseltamivir within 24 hours of hospitalization was associated with a shorter duration of hospital stay. Additional study is needed to determine the effect of delayed initiation of oseltamivir on clinical outcomes.

From the *Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA; †The Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; ‡The Center For Clinical Epidemiology and Biostatistics, The University of Pennsylvania School of Medicine, Philadelphia, PA; §Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; and ¶The Child Health Corporation of America, Shawnee Mission, KS.

Accepted for publication July 7, 2011.

Supported by a grant from the National Institute of Child Health and Human Development (5R03HD55966-2). T.E.Z. has received funding for investigator-initiated research from Merck. The other authors have no funding or conflicts of interest to disclose.

Address for correspondence: Susan E. Coffin, MD, MPH, Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104. E-mail:

© 2011 by Lippincott Williams & Wilkins, Inc.