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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
Reviving an old one since it’s pretty relevant again. Added some commentary in the Comments section.
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March 1, 2021 at 1:28 am
A useful discussion of the debate regarding oseltamivir use can be found at https://wwwnc.cdc.gov/eid/article/22/6/15-1037_article
The study cited in this article (Dobson J et al Lancet 2015;385:1729) plus a recent one in Lancet (Butler CC et al Lancet 2019 Dec 12) demonstrate that oseltamivir reduces symptom duration by approximately 1 day. Given the potential side effects, some question the risk benefit ratio. A nice summary of this point of view can be found at https://rebelem.com/the-tamiflu-debacle/ and more concisely https://rebelem.com/rebel-review/rebel-review-80-oseltamivir-tamiflu-for-treatment-of-influenza/oseltamivir-tamiflu-for-treatment-of-influenza/
However, literature does support that oseltamivir can reduce mortality in adults with high risk factors, if given early in the course of disease. Data are insufficient for kids, but are often extrapolated from adult data. We are currently in the throes of influenza season, and pediatric deaths is double that of the same time in last season https://www.medscape.com/viewarticle/923215
CDC recommendations for antiviral use can be found at: https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
Summary: hospitalized, severe/complicated illness, high risk for complications (includes children < 2 years old). Most likely to benefit if given in first 48 hours of illness. Personally, I have a hard time ignoring the CDC.
As those with non-influenza illness do not benefit from oseltamivir, and children have a high rate of other winter viruses, our hospital ID department recommends rapid influenza testing confirmation before initiating oseltamivir for children.