What to know about influenza antivirals and lowering risk of serious complications in kids

Children who received early antiviral treatment for influenza had a significantly lower risk of hospitalization and severe symptoms compared with those who did not receive early treatment, according to a team from the department of pediatric infectious diseases at MacKay Children's Hospital in Taipei, Taiwan. The multicentre retrospective case-control study, published in Pediatrics, included all children seen as outpatients for laboratory-confirmed influenza at participating hospitals between 2020 and 2023. The study included 1,492 children in total—354 cases who were hospitalized or died from influenza and 1,138 non-hospitalized controls matched by date of initial consultation and age group.Most patients (86.7%) were infected with influenza A. Among all participants, 80.8% received early antiviral treatment (within 48 hours of symptom onset), 18% received late antiviral treatment (more than 48 hours after symptom onset) and 1.1% received no antiviral treatment.Early treatmentChildren who received early antiviral treatment had significantly lower rates of hospitalization (16.1% versus 55.9%; p < 0.001) and severe influenza (0.7% versus 3.1%; p < 0.01) than those who received late antiviral treatment or no treatment.More specifically, early antiviral treatment was associated with 81% lower odds of hospitalization (adjusted OR: 0.19; 95% CI: 0.14–0.27), with similar protection among children aged five years or younger (adjusted OR: 0.19; 95% CI: 0.12–0.31)—a population particularly vulnerable to serious influenza complications—and those older than five years (adjusted OR: 0.15; 95% CI: 0.09–0.25).In contrast, the findings showed that antibiotic use during the first two days of illness appeared to be associated with an increased risk of hospitalization.Supplement to vaccination“It is important to emphasize that early antiviral therapy should not be used in lieu of vaccination but rather as a supplement to vaccination, particularly in children younger than six months who are not eligible for influenza vaccination,” the authors concluded. “Expanding timely access to antiviral treatment, coupled with rapid diagnosis, has the potential to substantially reduce the global burden of influenza in children.”Among the study's limitations, the researchers noted confounding by indication, whereby physicians may be more likely to prescribe antiviral treatment to children with more severe symptoms and a higher risk of hospitalization. According to the researchers, this could lead to an underestimation of the treatment's actual effectiveness.“Therefore, the actual benefit of early antiviral therapy in pediatric outpatients with influenza may be greater than our findings suggest,” they wrote.ReferenceHuang YN, Chang CJ, Dai YL, Kung YH, Huang CY, Huang DTN, et al. Early Antiviral Therapy in Pediatric Outpatients and Risk of Influenza-Related Hospitalization. Pediatrics. 2026;158(3):e2025075020. https://pubmed.ncbi.nlm.nih.gov/42604754/This article has been translated from its original French and first appeared on our sister site Profession Santé.

What to know about influenza antivirals and lowering risk of serious complications in kids

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