Antivirals Slightly Shorten Duration of Seasonal Flu in Children

Treatment was well tolerated and slightly reduced transmission to household contacts. 

Children may shed influenza virus longer than adults and are a main source of spread to household contacts. To examine the effect of antiviral treatment in children, researchers performed a meta-analysis of seven randomized controlled trials of neuraminidase inhibitors for outpatient treatment of seasonal influenza and postexposure prophylaxis in children aged 12 years or younger.

Two trials evaluated outpatient treatment with oseltamivir and two with zanamivir within 36 or 48 hours of onset of influenza-like symptoms.

• In a total of 1766 children (1243 with confirmed and 523 with suspected influenza), 
• treatment reduced median time to symptom resolution, return to normal activities, or both by 0.5 to 1.5 days; 
• reductions were statistically significant in one oseltamivir trial and one zanamivir trial. 
• Recovery was significantly faster in children with confirmed influenza than in those with suspected influenza.

Three trials evaluated 10-day courses of oseltamivir (1 trial) or zanamivir (2 trials) for postexposure prophylaxis in 863 children.

• Treatment was associated with an 8% decrease in the incidence of symptomatic influenza (number needed to treat to prevent 1 additional case, 13). 
• Compliance was high — 97% of children took more than 8 of the 10 doses of zanamivir and 90% took all 10 doses of oseltamivir. 
• Both drugs were well tolerated; however, the incidence of vomiting was 5% higher with oseltamivir than with placebo. 
• No deaths were reported.

Comment:
This meta-analysis suggests that neuraminidase inhibitors are well tolerated in children and that they slightly reduce symptom duration and household transmission of seasonal influenza. Whether these data apply to the 2009 influenza A (H1N1) virus pandemic is not clear.

Given that H1N1 disease has been mild so far in otherwise healthy children older than age 5 years, neuraminidase inhibitors cannot be recommended for routine outpatient treatment in low-risk children older than 5 years with uncomplicated suspected 2009 H1N1 influenza 

(JW Pediatr Adolesc Med Aug 21 2009).

— Kristi L. Koenig, MD, FACEP
Published in Journal Watch Emergency Medicine September 4, 2009