Bassett Hannah K, Rao Suchitra, Beck Jimmy, Brady Patrick W, Jhaveri Ravi, Joerger Torsten, Liang Danni, Quinonez Ricardo, Shine Alaina, Somers Maya, Lucas Brian P, Schroeder Alan R
Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
Divisions of Hospital Medicine and Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
Pediatrics. 2025 Sep 1;156(3). doi: 10.1542/peds.2025-071193.
Professional societies recommend antiviral treatment of all children at high risk for severe or complicated influenza disease, regardless of symptom duration. However, outpatient antiviral prescribing practices are inconsistent. We aimed to assess pediatric clinicians' outpatient prescribing practices for oseltamivir in children with influenza.
This vignette-based study of pediatric clinicians was conducted from March to June 2024 at 7 US children's hospitals and their affiliated clinics. The survey included 4 clinical influenza vignettes, 3 of which represented scenarios warranting treatment per national recommendations. One vignette was randomized to explore the impact of symptom duration on treatment preferences. Our primary outcome was the proportion of vignettes for which respondents were likely, somewhat or extremely, to recommend oseltamivir.
Of 1124 eligible participants, 452 (40.2%) responded to the survey. Successive wave analysis revealed no evidence of response bias. Participants were likely to recommend oseltamivir in 36.2% of cases, with variation among specialties (29.6% for emergency medicine, 37.2% for general pediatrics, and 48.6% for infectious diseases; P < .001) and among study sites from 28.6% to 50.7% (P = .018), adjusted for clustering. Longer symptom duration (2 vs 4 days) significantly decreased respondents' likelihood to recommend oseltamivir from 30.9% to 1.8% (P < .001).
We demonstrate considerable nonadherence to national influenza treatment recommendations and variability regarding the outpatient use of oseltamivir to treat children with influenza. This indicates uncertainty of the perceived benefit of oseltamivir in a relatively healthy pediatric population with non-severe disease. Treatment standardization in accordance with national guidelines and rigorous monitoring of subsequent outcomes is needed.
专业学会建议对所有有患严重或复杂流感疾病高风险的儿童进行抗病毒治疗，无论症状持续时间长短。然而，门诊抗病毒药物的处方做法并不一致。我们旨在评估儿科临床医生对流感患儿使用奥司他韦的门诊处方做法。
2024年3月至6月在美国7家儿童医院及其附属诊所开展了这项基于病例 vignette 的儿科临床医生研究。该调查包括4个临床流感病例 vignette，其中3个代表根据国家建议需要治疗的情况。随机选择1个病例 vignette 以探讨症状持续时间对治疗偏好的影响。我们的主要结局是受访者可能、有点或非常可能推荐奥司他韦的病例 vignette 的比例。
在1124名符合条件的参与者中，452人（40.2%）回复了调查。连续波分析未发现回复偏倚的证据。参与者在36.2%的病例中可能会推荐奥司他韦，各专业之间存在差异（急诊医学为29.6%，普通儿科学为37.2%，传染病学为48.6%；P < .001），各研究地点之间从28.6%到50.7%不等（P = .018），经聚类调整。症状持续时间较长（2天与4天）显著降低了受访者推荐奥司他韦的可能性，从30.9%降至1.8%（P < .001）。
我们证明了对国家流感治疗建议的相当程度的不遵守，以及在门诊使用奥司他韦治疗流感患儿方面的变异性。这表明在相对健康的非重症儿科人群中，奥司他韦的预期益处存在不确定性。需要根据国家指南进行治疗标准化，并对后续结果进行严格监测。
