A new survey of pediatricians shows less than half adhere to national recommendations for oseltamivir (Tamiflu) prescribing for children hospitalized with flu, and suggests randomized control trials of the antiviral drug in the pediatric population would help increase uptake.

The study was published late last week in Pediatrics, and is based on survey results from 787 physicians from five specialties working at seven US children's hospitals from March to June 2024.

All US children hospitalized for influenza are recommended, per the American Academy of Pediatrics (AAP), to receive oseltamivir during their hospital stay, but inpatient use of the drug is inconsistent the authors said. 

In the survey, clinicians were presented with four case description of patients and asked how likely they were to prescribe oseltamivir. All four case descriptions would meet the recommendations for oseltamivir use under current guidelines. 

Infectious disease doctors most ilk to recommend Tamiflu 

Overall, oseltamivir was recommended less than half the time (49.5%). Among clinicians with knowledge of guidelines, 62.0% recommended use, compared with 42.4% of clinicians who did not have accurate knowledge of guidelines.

Clinicians were less likely to prescribe the drug to patients with long illnesses or non-respiratory symptoms. Infectious disease specialists were most likely to recommend oseltamivir, while hospitalists were least likely to. 

Most respondents (87.4%) believed a randomized trial of oseltamivir in hospitalized children was moderately to extremely important,

"Most respondents (87.4%) believed a randomized trial of oseltamivir in hospitalized children was moderately to extremely important," the authors concluded. They wrote that hospital length of stay was the most pressing primary outcome to assess.

A study at a Minnesota healthcare system finds that limiting the use of the antiviral drug remdesivir (Veklury) in hospitalized COVID-19 patients didn't result in a greater risk of death.

"There is limited data to support routine remdesivir use in the contemporary era of SARS-CoV-2 with widespread seropositivity [evidence of previous infection or vaccination]," the HealthPartners researchers wrote.

The team compared COVID-19 patients' 14-day risk of death 12 months before and after implementation of remdesivir restrictions at the system's eight hospitals (June 2022 to May 2023 and July 2023 to June 2024, respectively). Of the 4,774 patients with healthy immune systems included in the analysis, 3,323 and 1,451 participated before and after the intervention, respectively.

The findings were published late last week in Clinical Infectious Diseases.

No difference in death, readmission, hospital stay

Significantly fewer patients in the post-implementation group were given remdesivir (37.7% pre-intervention vs 4.1% post-intervention). Models of medium-risk covariates found no difference in 14-day all-cause death rates between the two groups (odds ratio, 1.8; 95% confidence interval, 0.54 to 5.8) or in 28-day all-cause death rates, 30-day readmissions, or length of hospital stay. 

Remdesivir use was associated with an unexpected increased risk of ICU admission and MV within the post-intervention group only, which is likely explained by the higher-risk patient population that received remdesivir.

But remdesivir use was linked to a lower risk of intensive care unit (ICU) admission and need for mechanical ventilation (MV) before the intervention and a higher risk of these outcomes after.

"Remdesivir use was associated with an unexpected increased risk of ICU admission and MV within the post-intervention group only, which is likely explained by the higher-risk patient population that received remdesivir," the study authors wrote. "Prospective studies would be needed to definitively determine if highly vaccinated, immunocompetent patients benefit from remdesivir."

A coalition of food safety, public health, and consumer advocacy groups are urging Department of Health and Human Services Secretary Robert F. Kennedy Jr. to curb the use of antibiotics in the meat industry.

In a letter sent last week, the Food Animal Concerns Trust and 36 other organizations called on Kennedy to take four actions to reduce the amount of medically important antibiotics used by US farmers for food-animal production, which accounts for nearly two thirds of all medically important antibiotics sold in the United States. The groups have been warning for several years that widespread use of these antibiotics—which are also used in human medicine—in cows, pigs, and poultry is accelerating the antibiotic-resistance threat.

"The spread of superbugs, and the threat it represents, cannot be slowed without curbing the overuse of antibiotics," they wrote.

Ban on preventive use

The groups note that while sales of antibiotics for human medicine have declined in recent years with better antibiotic stewardship, US sales for animal use rose by more than 10% from 2017 to 2023. They contrast that with Europe, where use of antibiotics in food-animal production has steadily declined since 2010. 

The letter calls on Kennedy to prohibit the use of medically important antibiotics to prevent disease in food-animals in the absence of a diagnosed illness, a use that stewardship advocates have long argued is inappropriate and driven by unhealthy conditions on industrial farms. It also urges him to set national targets for reducing antibiotic use both in agriculture and human medicine, finalize guidance that limits durations of antibiotic use in food animals, and create a national monitoring system to track antibiotic use in food-animal production.

"As Secretary, you have the opportunity using existing authorities to make our food system much safer by implementing these steps to stop the overuse of antibiotics by the meat industry that is leading to the spread of deadly antibiotic-resistant pathogens," the letter states.

• After passing two incubation periods with no new cases, Uganda’s health ministry on April 26 declared the end of its sixth Ebola Sudan outbreak, which began in late January and led to 14 cases, 12 confirmed and 2 probable. Four people died from their infections. In a statement, the World Health Organization (WHO) said, “Although the outbreak has been declared over, health authorities are maintaining surveillance to rapidly identify and respond to any re-emergence. Risk communication and community engagement will also continue to ensure the community stay informed and stigma to those who were affected is minimized.”
• The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) today confirmed one more H5N1 avian flu detection in dairy cattle, a herd from Arizona. The state has now reported three detections since the middle of February, and the latest confirmation lifts the national total since March 2024 to 1,032 detections from 17 states.
• Valneva today announced that French drug regulators have updated their recommendation for the company’s chikungunya vaccine (Ixchiq) following reports of severe adverse reactions in older people with underlying health conditions who were immunized on a priority basis during the response to a large ongoing chikungunya outbreak in La Reunion and Mayotte. Officials are investigating three adverse events that required hospitalization, one of them fatal. The hospitalized patients were older than 80 years old and had preexisting conditions. In early March, the US Centers for Disease Control and Prevention (CDC) issued an alert, noting that it was investigating five hospitalization for cardiac and neurological events following Ixchiq vaccination in people ages 65 and older. Earlier this month, the CDC’s vaccine advisory panel recommended chikungunya vaccines from Valneva and Bavarian Nordic for certain at-risk groups, but added wording that being age 65 years and older is a precaution for receiving Valneva’s live-attenuated vaccine.