Clinician Preferences for Oseltamivir Use in Children With Influenza in the Outpatient Setting.

Objective: Professional societies recommend antiviral treatment of all children at high risk for severe or complicated influenza disease, regardless of symptom duration. However, outpatient antiviral prescribing practices are inconsistent. We aimed to assess pediatric clinicians' outpatient prescribing practices for oseltamivir in children with influenza.

Methods: This vignette-based study of pediatric clinicians was conducted from March to June 2024 at 7 US children's hospitals and their affiliated clinics. The survey included 4 clinical influenza vignettes, 3 of which represented scenarios warranting treatment per national recommendations. One vignette was randomized to explore the impact of symptom duration on treatment preferences. Our primary outcome was the proportion of vignettes for which respondents were likely, somewhat or extremely, to recommend oseltamivir.

Results: Of 1124 eligible participants, 452 (40.2%) responded to the survey. Successive wave analysis revealed no evidence of response bias. Participants were likely to recommend oseltamivir in 36.2% of cases, with variation among specialties (29.6% for emergency medicine, 37.2% for general pediatrics, and 48.6% for infectious diseases; P < .001) and among study sites from 28.6% to 50.7% (P = .018), adjusted for clustering. Longer symptom duration (2 vs 4 days) significantly decreased respondents' likelihood to recommend oseltamivir from 30.9% to 1.8% (P < .001).

Conclusions: We demonstrate considerable nonadherence to national influenza treatment recommendations and variability regarding the outpatient use of oseltamivir to treat children with influenza. This indicates uncertainty of the perceived benefit of oseltamivir in a relatively healthy pediatric population with non-severe disease. Treatment standardization in accordance with national guidelines and rigorous monitoring of subsequent outcomes is needed.