This is a prospective, randomized, double-blind, placebo-controlled trial that will be conducted in tertiary care pediatric hospitals in El Salvador and Panama. The primary purpose of this study is to determine whether empiric oseltamivir phosphate treatment given at the time of hospital admission to children less than 10 years of age hospitalized with influenza can effectively reduce their illness severity. Additional objectives are to: 1) evaluate the tolerability of oseltamivir phosphate treatment, 2) evaluate the effect of oseltamivir treatment on viral clearance and development of oseltamivir-resistant influenza virus during and after treatment in children hospitalized with influenza, 3) estimate the direct and indirect costs of all-cause respiratory illness and influenza-associated respiratory illness requiring hospitalization, and 4) evaluate the effect of empiric oseltamivir treatment during the influenza season on these costs. The primary study hypothesis is that children with laboratory-confirmed influenza receiving empiric oseltamivir phosphate treatment initiated at the time of hospital admission will have a shorter duration of hospitalization and a shorter time to resolution of signs of severe respiratory illness compared to children receiving placebo. The secondary study hypotheses are that children with laboratory-confirmed influenza receiving oseltamivir phosphate treatment will have a reduction in the time to non-detectable influenza virus and influenza viral RNA and children with all-cause respiratory illness receiving oseltamivir phosphate will not be more likely to experience severe adverse events than children receiving placebo.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
721
Hospital Nacional San Juan de Dios de San Miguel
San Miguel, El Salvador
Hospital Nacional San Juan de Dios de Santa Ana
Santa Ana, El Salvador
Hospital Jose Domingo de Obaldia
David, Panama
Hospital de Especialidades Pediátricas Omar Torrijos Herrera
Panama City, Panama
Hospital Del Nino
Panama City, Panama
Length of hospitalization
Day 1 is defined as the day of arrival at the emergency department
Time frame: Participants will be followed for the duration of hospital stay, an expected median of 7 days
Time to resolution of increased work of breathing
Increased work of breathing is defined as presence of 1 or more of the following: supraclavicular retractions, subcostal or intercostal retractions, nasal flaring, grunting, or need for noninvasive or invasive mechanical ventilation, and resolution is defined as 12 hours or more without increased work of breathing in a child with increased work of breathing at enrollment
Time frame: Participants will be followed for the duration of hospital stay, an expected median of 7 days
Time to resolution of hypoxia
Hypoxia is defined as O2 saturation less than 92% measured by pulse oximetry while breathing room air or need for noninvasive or invasive mechanical ventilation and resolution is defined as 12 hours or more without hypoxia in a child with hypoxia at enrollment
Time frame: Participants will be followed for the duration of hospital stay, an expected median of 7 days
Incidence of new onset respiratory failure 24 hours or more after first dose of study medication
Respiratory failure is defined by need for noninvasive or invasive mechanical ventilation
Time frame: Participants will be followed for the duration of hospital stay, an expected median of 7 days
Incidence of admission to intensive care unit 24 hours or more after first dose of study medication
Time frame: Participants will be followed for the duration of hospital stay, an expected median of 7 days
Incidence of death 24 hours or more after first dose of study medication
Time frame: Participants will be followed up through 7 days after hospital discharge
Time to non-detectable influenza virus by viral culture and non-detectable influenza viral RNA by RT-PCR
Time frame: Participants will be followed for the duration of hospital stay (an expected median of 7 days) or up through 21 days of hospitalization, whichever is shorter
Proportion of children with oseltamivir resistant virus detected during or after oseltamivir phosphate treatment who had oseltamivir susceptible virus infection at enrollment
Time frame: Participants will be followed for the duration of hospital stay (an expected median of 7 days) or up through 21 days of hospitalization, whichever is shorter
Proportion of participants experiencing adverse events (including severe and non-severe)
An adverse event is defined as any unfavorable or undesirable effect (sign, symptom, abnormality, or condition), regardless of causal relationship to study procedures or participation that occurs in participants while enrolled in this clinical trial. Any medical condition or sign/symptom that is present at the time the participant is screened is considered as baseline and not reported as an adverse event.
Time frame: Up through 7 days after hospital discharge
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