JAMA Netw Open

Influenza antiviral use in pediatric EDs dropped sharply during the COVID-19 pandemic

October 24, 2025

Study details: This multicenter cross-sectional study analyzed 2,514 influenza-positive children at higher risk for severe illness (age <5 or with comorbidities) presenting to seven U.S. pediatric academic emergency departments from 2016 to 2023. Data were stratified into pre-pandemic (2016–2020) and late pandemic (2021–2023) periods.

Results: Antiviral prescribing fell from 32.2% pre-pandemic to 15.6% post-pandemic, despite stable national recommendations. Prescriptions were more likely for children presenting within 48 hours of symptom onset (adjusted odds ratio [aOR], 4.08; 95% confidence interval [CI], 2.49-6.71) and those who underwent clinical influenza testing (aOR, 17.20; 95% CI, 4.08-72.37).

Clinical impact: This sharp decline signals a gap in guideline adherence and missed opportunities to reduce complications in high-risk pediatric patients. Emergency clinicians should reinforce early testing and treatment protocols, especially during peak influenza seasons.

Source:

Stopczynski T, et al. (2025, October 22). JAMA Netw Open. Changes in Antiviral Prescribing for Children With Influenza in US Emergency Departments. https://pubmed.ncbi.nlm.nih.gov/41123891/