Oseltamivir and influenza-related complications in children: a retrospective cohort in primary care.
Lee JJ., Smith M., Bankhead C., Perera Salazar R., Kousoulis AA., Butler CC., Wang K.
BACKGROUND: Influenza and influenza-like illness (ILI) place considerable burden on health care systems, especially during influenza epidemics and pandemics. During the 2009/10 H1N1 influenza pandemic, UK national guidelines recommended antiviral medications for patients presenting within 72 h of ILI onset. However, it is not clear whether antiviral treatment was associated with reductions in influenza-related complications. METHODS: Our study population consisted of a retrospective cohort of children aged 17 years or younger who presented with influenza/ILI at UK primary care practices contributing to the Clinical Practice Research Datalink during the 2009/10 pandemic. We used doubly robust inverse-probability weighted propensity scores and physician prior prescribing instrumental variable methods to estimate the causal effect of oseltamivir prescribing on influenza-related complications. Secondary outcomes were complications requiring intervention, pneumonia, pneumonia or hospitalisation, influenza-related hospitalisation and all-cause hospitalisation. RESULTS: We included 16 162 children of whom 4028 (24.9%) were prescribed oseltamivir, and 753 (4.7%) had recorded complications. Under propensity score analyses oseltamivir prescriptions were associated with reduced influenza-related complications (Risk Difference -0.015, 95% confidence interval [CI] -0.022 to -0.008), complications requiring further intervention, pneumonia, pneumonia or hospitalisation and influenza-related hospitalisation, but not all-cause hospitalisation. Adjusted instrumental variable analyses estimated reduced influenza-related complications (RD -0.032, 95%CI -0.051 to -0.013), pneumonia or hospitalisation, all cause and influenza-related hospitalisations. CONCLUSIONS: Based on causal inference analyses of observational data, oseltamivir treatment in children with influenza/ILI was associated with a small but statistically significant reduction in influenza-related complications during an influenza pandemic.