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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!
A repeat – since we are in the throes of influenza season right now, and this is a particularly controversial issue. Many emergency medicine FOAM bloggers have argued against the use of oseltamivir, such as here. But, the CDC continues to recommend it for high risk patients presenting with < 48 hours of symptoms, citing their reasoning here. To complicate things further, the “definition” of influenza-like illness basically includes nearly all kids seen in the ED in the wintertime – fever and cough or sore throat, and point-of-care tests are not very sensitive.
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February 23, 2018 at 5:21 pm
I use Tamiflu in patients with immunisuppresion, those with severe asthma (sometimes)…otherwise I have a conversation about who it’s recommended for, and the pros/cons of the drug. After that most parents seem to be happy without Tamiflu. I also use it for those patients who will not leave the ED without some “treatment” for their flu.
January 6, 2020 at 3:47 pm
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.