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Written by Sam Parnell
Early initiation of oseltamivir on the day of admission significantly reduced the severity of flu-related complications, ICU admissions, and risk of death in hospitalized adults with influenza.
Fast and flu-rious: need for speed with oseltamivir!
Influenza is a common yet unwelcome occurrence this time of year. Although most patients with influenza experience relatively mild symptoms, it can be associated with significant morbidity and mortality. The Infectious Diseases Society of America (IDSA) guidelines recommend initiation of oseltamivir as soon as possible, regardless of symptom duration for adults hospitalized with influenza. However, there is significant variability in the application of these guidelines and limited evidence related to the timing of antiviral therapy for adults admitted with influenza infection. This multicenter observational study evaluated whether early initiation of oseltamivir therapy improved outcomes in adults hospitalized with influenza between October 2022 and July 2023. Using a prospective design across 24 U.S. hospitals, 840 patients were analyzed. Early oseltamivir treatment (on the admission day) compared to late treatment or no treatment was associated with significantly lower peak pulmonary severity (aOR 0.60, 95%CI 0.49–0.72), reduced ICU admissions (aOR 0.24, 95%CI 0.13–0.49), less kidney replacement therapy or vasopressor support (aOR 0.40, 95%CI 0.22–0.67), and reduced in-hospital mortality (aOR: 0.36, 95%CI 0.18–0.72). It is important to note that this study evaluated oseltamivir effectiveness during a single influenza season, primarily involving the influenza A (H3N2) virus strain. As such, generalizing these findings to other influenza seasons and strains may be challenging. Nonetheless, these findings are consistent with previous studies demonstrating the therapeutic effectiveness of oseltamivir in prior influenza seasons.
How will this change my practice?
This study highlights the clinical benefits of starting antiviral treatment as soon as possible for adults hospitalized with influenza. Personally, I plan to follow the IDSA and CDC guidelines and administer oseltamivir to any patient with influenza infection who is sick enough to be admitted, even if symptom duration exceeds 48 hours.
Source
Benefit of early oseltamivir therapy for adults hospitalized with influenza A: an observational study. Clin Infect Dis. 2024 Nov 28:ciae584. doi: 10.1093/cid/ciae584. Epub ahead of print. PMID: 39607747
