Oseltamivir use for improved clinical outcomes in adult patients with influenza B - a best evidence topic report
BACKGROUND AND OBJECTIVES: Oseltamivir is frequently used in the Emergency Department for management of influenzas A and B. Currently, however, the main body of literature justifying the use of Oseltamivir is based on populations of predominantly or exclusively influenza A infections, and if influenza B is mentioned, often only virologic outcomes are recorded in favour of clinical outcomes. A short cut review was therefore carried out to establish whether Oseltamivir leads to faster alleviation of symptoms, fewer hospital admissions and lower mortality in adult patients presenting to the Emergency Department with influenza B.
METHODS: A mini-systematic review was undertaken between January and March 2018, looking at papers published from 1946 to present. Medline and Embase were searched for papers deemed relevant to the three-part question: In [adult patients presenting to the Emergency Department with influenza B] does [oseltamivir] lead to [faster alleviation of symptoms, fewer hospital admissions and lower mortality]? Results were limited to humans and English language and papers that did not conduct separate analysis according to influenza strain were explicitly excluded.
Altogether, 239 papers were found in Medline and 514 in Embase (753 in total) of which 751 were irrelevant or of insufficient quality. Two papers from Medline and zero from Embase were deemed directly relevant to the question. No further papers were found by scanning the references of relevant papers. The search was checked by the second author to ensure no relevant papers were missed. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers were tabulated.
RESULTS: The two papers found addressed clinical outcomes in adult patients prescribed oseltamivir with confirmed influenza B, and suggested that oseltamivir administration shortened duration of fever in both influenza A and B patients (p<0.001). These outcomes, however, were addressed in an outpatient setting, and both papers originate from the same research group on another continent thus limiting their relevance with regards to the patient population. The outcomes have further limitations: there is no mention of mortality, and a reduction in duration of fever is more likely a population benefit more than an individual benefit for the patient (though this is not proven).
DISCUSSION AND CONCLUSIONS: The clinical bottom line is that there is evidence that oseltamivir may reduce the duration of fever in influenza B infections, however no evidence that oseltamivir influences clinical outcomes (such as mortality or length of hospital admission) in influenza B infections. More research needs to be done to address this.
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