Recent concern has been expressed about the routine use of
oseltamivir in the treatment of children with influenza. It is
inappropriate given the collective data to suggest that treatment with
antiviral medications is not of benefit to children with influenza. The
CDC advises that clinical judgment is an important factor in treatment
decisions. Physicians should continue to follow guidance from health
authorities, as appropriate to seasonal influenza or pandemic H1N1.
As we begin to learn more about novel H1N1, we have only identified a few
high risk patient groups (e.g. neurocognitive dysfunction, neuromuscular
disability, etc.) for whom therapy is imperative. However, we now have
normal children who have developed progressive life-threatening disease.
In the absence of biomarkers that predict disease progression,
withholding antiviral therapy could result in more serious illness, as is
already being reported with novel H1N1.
In our own study, we enrolled 695 children in a randomized, double-
blind, placebo-controlled analysis, and clearly demonstrated significant
treatment benefits:
• Reduction of new diagnoses of otits media infections (by 44%)
• Lower incidence of physician-prescribed antibiotics
• Reduction in median duration of illness by 36 hours
• Reduction of cough, coryza and duration of fever.
No evidence of drug toxicity was found. We did not detect an increased
rate of resistance. Further, with regard to safety, based on a review of
data and clinical reports, the U.S. FDA recently granted Emergency Use
Authorization for oseltamivir in treatment and prophylaxis of pandemic
H1N1 in pediatric patients 1 year and younger.
Children have been disproportionally impacted by novel H1N1. As they
return to school in the western hemisphere, there’s no doubt that American
and European clinics and hospitals will be caring for thousands of
influenza-infected children. Health professionals must continue to follow
public health guidance and apply clinical judgment with regard to
pharmacologic interventions.
While prudent physicians always worry about toxicity and are concerned
about the development of resistance, the body of evidence supports
oseltamivir as an effective treatment of novel H1N1 in children and
adults. Antiviral therapy will be especially important until an effective
vaccine can be developed and widely distributed.
Ref: Oral oseltamivir treatment of influenza in children; Journal of
Pediatric Infectious Diseases, April 2001
Competing interests:
I am on the Board of Directors of Gilead Sciences
Rapid Response:
Children with novel H1N1 Warrant Treatment
Recent concern has been expressed about the routine use of
oseltamivir in the treatment of children with influenza. It is
inappropriate given the collective data to suggest that treatment with
antiviral medications is not of benefit to children with influenza. The
CDC advises that clinical judgment is an important factor in treatment
decisions. Physicians should continue to follow guidance from health
authorities, as appropriate to seasonal influenza or pandemic H1N1.
As we begin to learn more about novel H1N1, we have only identified a few
high risk patient groups (e.g. neurocognitive dysfunction, neuromuscular
disability, etc.) for whom therapy is imperative. However, we now have
normal children who have developed progressive life-threatening disease.
In the absence of biomarkers that predict disease progression,
withholding antiviral therapy could result in more serious illness, as is
already being reported with novel H1N1.
In our own study, we enrolled 695 children in a randomized, double-
blind, placebo-controlled analysis, and clearly demonstrated significant
treatment benefits:
• Reduction of new diagnoses of otits media infections (by 44%)
• Lower incidence of physician-prescribed antibiotics
• Reduction in median duration of illness by 36 hours
• Reduction of cough, coryza and duration of fever.
No evidence of drug toxicity was found. We did not detect an increased
rate of resistance. Further, with regard to safety, based on a review of
data and clinical reports, the U.S. FDA recently granted Emergency Use
Authorization for oseltamivir in treatment and prophylaxis of pandemic
H1N1 in pediatric patients 1 year and younger.
Children have been disproportionally impacted by novel H1N1. As they
return to school in the western hemisphere, there’s no doubt that American
and European clinics and hospitals will be caring for thousands of
influenza-infected children. Health professionals must continue to follow
public health guidance and apply clinical judgment with regard to
pharmacologic interventions.
While prudent physicians always worry about toxicity and are concerned
about the development of resistance, the body of evidence supports
oseltamivir as an effective treatment of novel H1N1 in children and
adults. Antiviral therapy will be especially important until an effective
vaccine can be developed and widely distributed.
Ref: Oral oseltamivir treatment of influenza in children; Journal of
Pediatric Infectious Diseases, April 2001
Competing interests:
I am on the Board of Directors of Gilead Sciences
Competing interests: No competing interests