There is still debate in the literature as to whether neuraminidase inhibitors reduce mortality in patients with influenza, with most of the data on influenza virus A(H1N1)pdm09. The authors were interested in whether early oseltamivir treatment within 48 hours of symptom onset decreases mortality compared with late treatment in critically ill patients with influenza of all types. They included adults with laboratory-confirmed influenza hospitalised in intensive care units (ICU) in Greece between 2010 and 2018, and treated with oseltamivir. 1330 patients were included, 46.8% of which died in ICU. Among patients with influenza A(H3N2), the authors found that early treatment was associated with significantly lower mortality (relative risk [RR] 0.69, 95%CI 0.49-0.94). This effect was due to an increased cause-specific hazard for discharge, while the cause-specific hazard for death was not increased. Among the survivors, the median length of ICU stay was shorter with early treatment by 1.8 days. No effect on mortality seen in patients infected with A(H1N1) and influenza B. Therefore severely ill patients with suspected influenza should be promptly treated with oseltamivir, particularly when A(H3N2) is circulating.
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