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Clin Infect Dis. 2018 Oct 9. doi: 10.1093/cid/ciy860. [Epub ahead of print]

Early oseltamivir after hospital admission is associated with shortened hospitalization: A five-year analysis of oseltamivir timing and clinical outcomes.

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Division of Pulmonary and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Division of Radiology, Duke University, Durham, NC.
Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.



Neuraminidase inhibitors (NAIs) are currently the only effective therapy for influenza infections, but few studies have assessed the impact of early NAI therapy in hospitalized patients on clinical outcomes or the patient-level factors that determine early NAI delivery.


We conducted a retrospective cohort study of all adults hospitalized in a metropolitan tertiary care hospital with confirmed influenza from April 2009 to March 2014. We performed logistic regression to determine patient-level factors that were associated with early NAI therapy. We analyzed the association of early NAI therapy with hospital length of stay (LOS) and in-hospital mortality using linear and logistic regression, respectively.


699 patients were admitted with influenza during the 5 influenza seasons. 582 (83.4%) received NAI therapy, however, only 26.0% received the first dose within 6 hours of hospitalization (early NAI). Patients with diabetes mellitus or pregnancy were more like to receive early NAI (p=0.01, p<0.001) as were those reporting fever or myalgias at presentation (p=0.002, p=0.005). Immunosuppressed patients were less likely to receive early NAI (p=0.04). Early NAI was associated with shorter hospital LOS (p<0.001). No patients died in the early NAI group compared to 18 deaths in the 399 patients receiving NAI after 6 hours (4.5%) and 4 deaths in the 116 patients not receiving NAI (3.4%).


Over multiple influenza seasons, early NAI therapy was associated with shorter LOS in patients admitted with influenza.  This suggests that efforts should focus on facilitating earlier therapy in patients with suspected influenza.


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