No One Likes Oseltamivir

Guidelines aren't enough when the evidence base is weak.

Oseltamivir is recommended for all children hospitalized with influenza, regardless of illness severity or symptom duration.

How’s that panning out?

This study produced a survey of clinicians, asking their likelihood of prescribing oseltamivir in a number of representative scenarios, and, as you can see from this sample, the results are very far from the guidelines:

These are just survey data, with all the associated biases and warts associated with this method, but they are broadly consistent with the results of prior retrospective reviews: clinicians are sour on oseltamivir.

The authors also report their findings to a few other accompanying survey questions and find that, no, not all clinicians surveyed were aware of the guideline recommendations for oseltamivir. However, even those who were aware still declined to treat hospitalized children approximately 40% of the time. There was also variability by study site and specialty of the respondent, with infectious disease specialists displaying the highest likelihood of oseltamivir use. Finally, there was one unifying result: a high-quality RCT is needed. Nearly 90% of respondents felt equipoise exists for revisiting these recommendations in a new trial.

Regardless of the topic, these data offer another interesting look at the limitations of guidelines as far as influencing clinician behavior. Considering the other various “controversies” floating around in U.S. medical culture right now, it will be interesting to see what sort of evidence, and produced by whom, can actually move the needle on practice change.