Kids Hospitalized for Flu Need Antiviral Meds Right Away: Study
Survival odds increase with early administration of drugs such as oseltamivir, researchers say
Despite these numbers, hospitals appear reluctant to use NAIs when treating kids sick enough from the flu to require hospitalization.
About 90 percent of kids in the ICU with the flu received NAIs during the 2009 H1N1 flu pandemic, the researchers found. Only 63 percent of kids, however, received NAIs in the years following the pandemic.
"I'm not at all sure why that percentage was so low," said Dr. Rich Whitley, professor of pediatric infectious diseases at the University of Alabama at Birmingham. "There's no good reason for that."
Cost shouldn't be a factor, Louie said. "The cost of oseltamivir, the most commonly prescribed NAI, is approximately $7 per pill," she said. "The usual treatment course is one pill twice a day for five days, for a total $70."
The drug's side effects also should not be an issue. The main side effects are nausea and vomiting, which are much more common in children but occur in less than 10 percent of patients.
The explanation might be that smaller hospitals that treat fewer cases of the flu do not have the same level of experience and sense of urgency as hospitals that regularly deal with flu outbreaks, Ramilo said.
"If you work in a big teaching hospital, then you see these cases more often," he said. "The [doctors] think about it right away."
Some doctors also may not suspect flu when they start treating a very sick child. "Many clinicians may not initially consider influenza as a possible cause of respiratory illness or pneumonia, especially when it occurs outside of the peak of the influenza season," Louie said.
Another problem could be that intravenous forms of the antiviral medications currently are not available, Ramilo said. Kids have to take them by mouth, and very sick kids often are administered the medication via a tube snaked through their nose and down their throat.
Although this study lends hope for treating critically ill children, Ramilo and Whitley said flu shots remain the first and best line of defense against the flu.
"Children need to be immunized just like adults need to be immunized," Whitley said. "It's still the best approach we have to prevent influenza."