title: The validity of clinical practice guidelines for empirical use of oseltamivir for influenza in Thai children.
abstract: BACKGROUND
  Clinical practice guidelines for influenza have been implemented to maximise the appropriate use of empirical oseltamivir; however, good predictive values are required.
  
  
  METHODS
  Between October 2011 and September 2013, children aged < 15 years who presented at the Bamrasnaradura Infectious Diseases Institute with an influenza-like illness plus either (i) pneumonia or (ii) being in a higher risk group for influenza complications were prospectively enrolled. Respiratory specimens were taken for real-time polymerase chain reaction testing (RT-PCR). Clinical characteristics, laboratory data and oseltamivir therapy were recorded.
  
  
  RESULTS
  85 cases were enrolled. Of these, the proportions of those with pneumonia, who were aged < 2 years and who had underlying diseases were 74.1%, 56.5% and 38.8%, respectively. RT-PCR detected respiratory syncytial virusamong (35.3%), influenza (22.3by%), adenovirus (14.1%), human metapneumovirus (5.9%), para-influenza (3.5%) and no viruses (25.9 %). Pneumonia (OR 0.16, 95% CI 0.05-0.50) and having two clinical criteria (OR 0.24, 95% CI 0.08-0.76) were significantly negative predictors of influenza. Having cluster transmissions (OR 5.18, 95% CI 1.38-19.37) and a monocyte proportion >7% (OR 3.58, 95% CI 1.15-11.17) were significantly positive predictors of influenza. The mean (SD) percentage of influenza-like illness during the study period was 7.04 (2.02).
  
  
  CONCLUSIONS
  Clinical criteria guidelines yielded a low predictive value (22.3%) for influenza in children. Seasonality, cluster transmission, white blood cell and differential counts may be helpful in diagnosing influenza. Nonetheless, empirical oseltamivir should not be delayed for those in need.
authors: a Paediatric Unit, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health (MOPH) , Nonthaburi , Thailand.
authors: Jurai
authors: J
authors: Wongsawat
authors: b Thai National Influenza Center, National Institute of Health, MOPH , Nonthaburi , Thailand.
authors: Malinee
authors: M
authors: Chittaganpitch
authors: c Nursing Section, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health (MOPH) , Nonthaburi , Thailand.
authors: Somtavil
authors: S
authors: Ampornareekul
authors: d Laboratory Section, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health (MOPH) , Nonthaburi , Thailand.
authors: Somkid
authors: S
authors: Srisophaa
authors: d Laboratory Section, Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health (MOPH) , Nonthaburi , Thailand.
authors: Sirirat
authors: S
authors: Likanonsakul
mesh_terms: D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D053139:Oseltamivir / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013785:Thailand
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir
keywords: Empirical oseltamivir; Higher risk groups for influenza complications; Lower respiratory tract viral infections; Pneumonia