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Reader Remarks on:

Oseltamivir Prevents Complications of Influenza in High-Risk Children

• oseltamivir
• Resistence to Oseltamivir
• No mention of death rates between the groups was offered.
• Death rates
• oseltamivir resistance
• Not comparative effectiveness research
• Author response to David Herr on comparative effectiveness research

oseltamivir

rt lis, 6 Aug 2009 8:57 AM EST

Competing interests: None declared

In my opinion, this article is an 'excellent example' of an industry sponsored study that found to its advantage. Did the authors investigate any neuropsychiatric effects of oseltamivir including nightmares, delerium, and suicides in children and adolescents, that have been reported and that need to be verified to honestly determine risk versus benefit? For the benefit of all patients, pediatric and adult, these side effects need to be objectively addressed and these questions answered.

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Resistence to Oseltamivir

Rodolfo Milani - Jr, Sao Paulo University - Brazil, 6 Aug 2009 10:54 AM EST

Competing interests: None declared

During last flu season, almost all (99,6%) seasonal Influenza A H1N1 were resistant to oseltamivir. A question: are this paper relevant to our practice nowadays?

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No mention of death rates between the groups was offered.

Leonard M. Saputo, 6 Aug 2009 11:32 AM EST

Competing interests: None declared

What was the difference in death rates between the two groups?

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Death rates

Lyn Whinston-Perry, Executive Editor, JW Pediatrics and Adolescent Medicine, 10 Aug 2009 1:25 PM EST

Competing interests: None declared

Specialty: Unknown

The study outcomes were frequencies of pneumonia, respiratory illnesses other than pneumonia, otitis media, and hospitalization. The authors did not report death rates.

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oseltamivir resistance

Peggy Sue Weintrub, MD, Associate Editor, JW Pediatrics and Adolescent Medicine, 11 Aug 2009 3:28 PM EST

Competing interests: None declared

Dr. Milani poses an insightful question and points out a difficulty we will all face in the upcoming respiratory season. Last year, a significant percentage of seasonal influenza was resistant to oseltamivir, however almost all of novel H1N1 is sensitive to this drug. Because a positive flu A test will not differentiate in "real time" between seasonal and H1N1, for high risk patients, it may be necessary to treat with two drugs. The CDC is expected to provide revised guidelines to address this issue in the early fall.

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Not comparative effectiveness research

David S. Herr, 27 Aug 2009 12:29 PM EST

Competing interests: None declared

Dear Dr. Bauchner, I respectfully disagree with your statement that this article is an example of comparative effectiveness research, because the only comparison group involved children who were not treated with oseltamivir. I would have expected a comparison with another drug. I would characterize this article as a retrospective study using administrative data only and requiring further research.

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Author response to David Herr on comparative effectiveness research

Howard Bauchner, MD, JW Pediatr Adolesc Med, Associate Editor, 31 Aug 2009 2:53 PM EST

Competing interests: None declared

David -

Seems like a fair point - but in this case are there any other drugs that could have been used? I appreciate the ongoing concern about drug - placebo comparison - but in this case I am not sure there was any option.

Howard

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