title: Treatment with oseltamivir in children hospitalized with community-acquired, laboratory-confirmed influenza: review of five seasons and evaluation of an electronic reminder.
abstract: BACKGROUND
  When initiated within 48 hours of the onset of symptoms, oseltamivir has been shown to reduce severity and length of influenza illness. Few studies have evaluated the use of oseltamivir in patients hospitalized with influenza.
  
  
  OBJECTIVE
  To describe the prescribing practices for oseltamivir in children hospitalized with influenza and to evaluate a mechanism to improve the rate of appropriate prescription.
  
  
  METHODS
  Retrospective cohort study of 929 patients aged 21 years or younger hospitalized with community-acquired laboratory-confirmed influenza (CA-LCI) during 5 consecutive seasons (2000-2005). We examined oseltamivir eligibility, which included patients 1 year of age or older with an influenza test result available within 48 hours of symptom onset. During the 2005-2006 season, an observational trial of an electronic reminder was conducted to improve the frequency of oseltamivir prescription.
  
  
  METHODS
  Oseltamivir prescription.
  
  
  RESULTS
  Of 305 patients (32.8%) eligible for treatment with oseltamivir, 49 (16.1% of those eligible) were prescribed oseltamivir during hospitalization. Prescription rates for indications consistent with the US Food and Drug Administration (FDA) approval ("on label") increased from 0% to 37.2% over 5 seasons (P < 0.0001). Prescriptions outside this recommendation ("off label") also increased over 5 seasons (P < 0.0001). Twenty-nine (5%) of 624 patients were treated with oseltamivir off label; 11 were less than 1 year of age. Initiation of a reminder had no impact on prescription (P > 0.05).
  
  
  CONCLUSIONS
  Oseltamivir was used infrequently for children hospitalized with influenza. In addition, use inconsistent with the FDA label of oseltamivir occurs. Mechanisms are needed to improve appropriate prescription of oseltamivir.
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Wilkes
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
authors.forename: Bimal
authors.initials: B
authors.lastname: Desai
authors.forename: Kateri H
authors.initials: KH
authors.lastname: Leckerman
authors.forename: Richard L
authors.initials: RL
authors.lastname: Hodinka
authors.forename: Talene A
authors.initials: TA
authors.lastname: Metjian
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
mesh_terms: D000293:Adolescent; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007251:Influenza, Human / Q000175:diagnosis / Q000188:drug therapy*; D053139:Oseltamivir / Q000008:administration & dosage / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D017010:Reminder Systems; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir