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Early antiviral treatment is linked with fewer intensive care unit (ICU) admissions and shorter hospital stays for children with influenza, the results of a cohort study have suggested.
Publishing their findings in JAMA Pediatrics on 10 August 2026, researchers found that children who received early antiviral treatment — in this case oseltamivir (Tamiflu; Roche) — were 31% less likely to be admitted to an ICU and had shorter hospital stays than those who did not receive the antiviral.
During the study, which was led by the University of Colorado Anschutz, researchers analysed data from more than 7,000 paediatric hospitalisations across 13 US states and 8 influenza seasons.
Senior author Suchitra Rao, professor in the department of paediatrics at the University of Colorado Anschutz School of Medicine and infectious disease specialist at Children’s Hospital Colorado, noted: “After one of the most severe influenza seasons in the past two decades, these findings reinforce the importance of treating children with influenza who are hospitalised. Our findings show that oseltamivir treatment can decrease the risk of needing critical care, even if started beyond the first two days of the start of the illness.
“Earlier studies were often missing key information about when children became sick or whether they started antiviral treatment before being hospitalised, making it harder to evaluate the medication’s effectiveness. By capturing those details and using advanced statistical methods, we were able to produce stronger real-world evidence to inform the care of children hospitalised with influenza.”
In the UK, oseltamivir is a first-line treatment for children with risk factors or severe influenza, while children without risk factors with confirmed or suspected influenza are treated with oseltamivir if severe enough to require admission to intensive care or high dependency units.
Stephen Tomlin, professional lead of the Neonatal and Paediatric Pharmacy Group, said: “This is one of the strongest real-world studies we’ve seen showing that antiviral treatment can make a meaningful difference for children admitted to hospital with flu.
“The finding that early oseltamivir treatment was associated with fewer intensive care admissions and shorter hospital stays is particularly important following the severe influenza seasons we’ve experienced in recent years. Importantly, the study suggests there may still be benefits even when treatment is started more than 48 hours after symptoms begin.
“Oseltamivir has been available for many years, but evidence from large real-world studies in children has been relatively limited. This analysis of more than 7,000 hospitalisations provides valuable reassurance that antiviral treatment remains an important part of managing severe influenza in children.
“Although this was an observational study and cannot prove cause and effect in the same way as a randomised controlled trial, the researchers used robust methods to account for when symptoms started and when treatment was given.”
Tomlin added that the study supports the effectiveness of oseltamivir and its current use in high-risk children in the UK. The findings of the study could also support a rationale for expanding its use to all children hospitalised with influenza, he said.
However, Tomlin noted that a national decision on the cost-effectiveness of this would need to be made by the National Institute for Health and Care Excellence.
Current guidance from the UK Health Security Agency (UKHSA) supports the use of oseltamivir as the first line of treatment for severe influenza in children. Oseltamivir reduces viral replication, while treatment works best when started within 48 hours of symptom onset, although it can be given after this.
There is no requirement or recommendation to wait until critical care to prescribe oseltamivir, instead the UKHSA recommends prompt treatment.
