Publicação
A realidade da prescrição de oseltamivir em crianças internadas num hospital pediátrico terciário.
| Resumo: | Introduction: Oseltamivir is the most commonly used drug for the treatment of influenza infection and its complications. It is recommended its use in all hospitalized children regardless the clinical status. The main goal of this study was to characterized hospitalized cases in a pediatric hospital with influenza infection after the influenza A pandemic, focusing on the use of oseltamivir and the factors that led to its prescription. Methods: Observational study, with retrospective data collection, including all cases hospitalized with influenza infection, in the Pediatric Hospital, Hospital and University Center of Coimbra (HP-CHUC) between October 2012 and May 2016 (four influenza seasons). The following variables were analyzed: admission year, age, gender, risk factors for severe infection, clinical presentation, changes in chest radiography, influenza virus detected, co-infection with other viruses, place of hospitalization, need for oxygen therapy and/or ventilatory support, oseltamivir prescription, concomitant antibiotic therapy and evolution. Statistical analysis made with SPSS® 22 (p<0.05). Results: A total of 83 cases with influenza infection (54,2% of the total number of positive tests for influenza virus) were included, corresponding to 81 children / adolescents, 45 (55.6%) of whom were male. The median age at the observation date was 21.9 months (AIQ 12-61). There were 40 cases with risk factors for severe infection (48.2%). There were 44 cases (53%) treated with oseltamivir. The most common clinical diagnoses were respiratory infection, namely pneumonia in 34 cases (40.9%). Four subtypes of influenza virus were included in this study: A(H1N1)pdm09 55 cases (64.7%), A (H3) 7 cases (8.2%), A indeterminate subtype 6 cases (7.1%) and B 17 Cases (20.0%).There was a statistically significant association between the prescription of oseltamivir and the following variables: place of hospitalization (p=0.006), number of days of hospitalization (p=0.002), changes in chest radiography (p=0.001), diagnosis of pneumonia (p=0.008), hypoxemia (p=0.001) and infection by influenza A(H1N1) virus pdm09 (p<0.001). There were three deaths (3.6%) and one case (1.2%) had permanent neurological sequels. Discussion and conclusion: Although the prescription of oseltamivir is lower than recommended, its use has been increasing in the last seasons. Treatment with oseltamivir was strongly associated with the identification of a specific subtype of influenza virus (A(H1N1) pdm09). We believe it is necessary to promote the use of oseltamivir in this age group. |
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| Autores principais: | Neto, Vanda Sofia Freitas Devesa |
| Assunto: | Influenza Vírus influenza A, subtipo H1N1 Criança Fatores de Risco Oseltamivir Influenza Influenza A virus, H1N1 subtype Child Risk Factors Oseltamivir |
| Ano: | 2017 |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | acesso embargado |
| Instituição associada: | Universidade de Coimbra |
| Idioma: | português |
| Origem: | Estudo Geral - Universidade de Coimbra |
| Resumo: | Introduction: Oseltamivir is the most commonly used drug for the treatment of influenza infection and its complications. It is recommended its use in all hospitalized children regardless the clinical status. The main goal of this study was to characterized hospitalized cases in a pediatric hospital with influenza infection after the influenza A pandemic, focusing on the use of oseltamivir and the factors that led to its prescription. Methods: Observational study, with retrospective data collection, including all cases hospitalized with influenza infection, in the Pediatric Hospital, Hospital and University Center of Coimbra (HP-CHUC) between October 2012 and May 2016 (four influenza seasons). The following variables were analyzed: admission year, age, gender, risk factors for severe infection, clinical presentation, changes in chest radiography, influenza virus detected, co-infection with other viruses, place of hospitalization, need for oxygen therapy and/or ventilatory support, oseltamivir prescription, concomitant antibiotic therapy and evolution. Statistical analysis made with SPSS® 22 (p<0.05). Results: A total of 83 cases with influenza infection (54,2% of the total number of positive tests for influenza virus) were included, corresponding to 81 children / adolescents, 45 (55.6%) of whom were male. The median age at the observation date was 21.9 months (AIQ 12-61). There were 40 cases with risk factors for severe infection (48.2%). There were 44 cases (53%) treated with oseltamivir. The most common clinical diagnoses were respiratory infection, namely pneumonia in 34 cases (40.9%). Four subtypes of influenza virus were included in this study: A(H1N1)pdm09 55 cases (64.7%), A (H3) 7 cases (8.2%), A indeterminate subtype 6 cases (7.1%) and B 17 Cases (20.0%).There was a statistically significant association between the prescription of oseltamivir and the following variables: place of hospitalization (p=0.006), number of days of hospitalization (p=0.002), changes in chest radiography (p=0.001), diagnosis of pneumonia (p=0.008), hypoxemia (p=0.001) and infection by influenza A(H1N1) virus pdm09 (p<0.001). There were three deaths (3.6%) and one case (1.2%) had permanent neurological sequels. Discussion and conclusion: Although the prescription of oseltamivir is lower than recommended, its use has been increasing in the last seasons. Treatment with oseltamivir was strongly associated with the identification of a specific subtype of influenza virus (A(H1N1) pdm09). We believe it is necessary to promote the use of oseltamivir in this age group. |
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