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Neuraminidase inhibitor treatment initiated upon hospitalization decreased patients’ length of stay by 19% overall during the 2009-2010 influenza pandemic, according to findings from a meta-analysis. “The most pragmatic and important question is whether [neuraminidase inhibitor (NAI)] treatment, started on admission, irrespective of delay since symptom onset, reduces the [length of stay] in hospitalized patients with influenza,” Sudhir Venkatesan, PhD, MPH, research assistant in the University of Nottingham’s division of epidemiology and public health, and colleagues wrote. “Clinically, this is important because there can be significant uncertainty in ascertaining symptom onset, even by the attending physician.”
The meta-analysis included data on 18,309 patients infected with the pandemic influenza A(H1N1) virus from 70 clinical centers in 36 countries, and excluded patients with a length of stay less than 1 day and individuals who died while hospitalized. The study results showed a 19% overall reduction in length of stay among patients who were promptly administered NAI treatment upon hospitalization compared with those who received it later or not at all (incidence rate ratio, 0.81; 95% CI, 0.78-0.85), with a median decrease of 1.19 days.
NAI treatment initiated less than 2 days after the onset of symptoms as well as NAI treatment administered at any time showed mixed patterns of association with a patient’s length of stay, the researchers reported. They observed an 8% decrease in length of stay in patients who were treated on the day of admission and not admitted to the ICU, and a 28% increase in promptly treated patients with chest radiography-confirmed influenza-related pneumonia.
The study was published July 17 in the Journal of Infectious Diseases:
The study evaluated patients treated with several NAI, including oselttamivir, peramivir or zanamivir. Unfortunately, the results were not reproduced in children (only adults), and the authors provide some explanations for this.