Pediatrics

Oseltamivir prescribing for children with flu often inconsistent with guidelines

August 15, 2025

Study details: A multicenter, vignette-based survey was conducted from March to June 2024 across 7 U.S. children's hospitals and affiliated clinics, targeting pediatric clinicians. Four clinical vignettes were used, 3 of which aligned with national recommendations for oseltamivir treatment. One vignette was randomized to assess the impact of symptom duration on prescribing preferences. The primary outcome was the proportion of vignettes for which clinicians were likely to recommend oseltamivir.

Results: Of 1,124 eligible clinicians, 452 (40.2%) responded. Oseltamivir was likely to be recommended in only 36.2% of cases, with significant variation by specialty (emergency medicine: 29.6%, general pediatrics: 37.2%, infectious diseases: 48.6%; P < 0.001) and by site (range: 28.6%–50.7%; P = 0.018). Longer symptom duration (4 vs. 2 days) markedly reduced likelihood of prescribing (1.8% vs. 30.9%; P < 0.001).

Clinical impact: Substantial nonadherence to national guidelines and heterogeneity in outpatient oseltamivir use for pediatric influenza persist, particularly in otherwise healthy children with non-severe disease. The observed reluctance to prescribe beyond 48 hours of symptom onset underscores ongoing uncertainty regarding oseltamivir's perceived benefit in this population. Standardization of treatment practices and outcome monitoring are needed to align with national recommendations.

Source:

Bassett HK, et al. (2025, August 13). Pediatrics. Clinician Preferences for Oseltamivir Use in Children With Influenza in the Outpatient Setting. https://pubmed.ncbi.nlm.nih.gov/40796188/