BACKGROUND Influenza antivirals improve outcomes in children with duration of symptoms <2 days and those at high risk for influenza complications. Real-world prescribing of influenza antivirals in the pediatric population is unknown. METHODS We performed a cross-sectional study of outpatient and emergency department prescription claims in individuals <18 years of age included in the IBM Marketscan Commercial Claims and Encounters Database between July 1, 2010 and June 30, 2019. Influenza antiviral use was defined as any dispensing of oseltamivir, baloxavir, or zanamivir. The primary outcome was the rate of antiviral dispensing per 1000 enrolled children. Secondary outcomes included antiviral dispensing per 1000 influenza diagnoses and inflation-adjusted costs of antiviral agents. Outcomes were calculated and stratified by age, acute versus prophylactic treatment, influenza season, and geographic region. RESULTS The analysis included 1 416 764 unique antiviral dispensings between 2010 and 2019. Oseltamivir was the most frequently prescribed antiviral (99.8%). Dispensing rates ranged from 4.4 to 48.6 per 1000 enrolled children. Treatment rates were highest among older children (12-17 years of age), during the 2017 to 2018 influenza season, and in the East South Central region. Guideline-concordant antiviral use among young children (<2 years of age) at a high risk of influenza complications was low (<40%). The inflation-adjusted cost for prescriptions was $208 458 979, and the median cost ranged from $111 to $151. CONCLUSIONS There is wide variability and underuse associated with influenza antiviral use in children. These findings reveal opportunities for improvement in the prevention and treatment of influenza in children.

中文翻译：

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美国儿童和青少年门诊流感抗病毒药物使用趋势。

背景流感抗病毒药物可改善症状持续时间<2天的儿童和流感并发症高风险儿童的预后。现实世界中儿童群体中流感抗病毒药物的处方情况尚不清楚。方法 我们对 2010 年 7 月 1 日至 2019 年 6 月 30 日期间 IBM Marketscan 商业索赔和遭遇数据库中 18 岁以下个人的门诊和急诊处方处方索赔进行了横断面研究。流感抗病毒药物的使用被定义为任何奥司他韦、巴洛沙韦或扎那米韦的配药。主要结果是每 1000 名登记儿童的抗病毒药物配药率。次要结果包括每 1000 例流感诊断中的抗病毒药物配药量以及经通货膨胀调整后的抗病毒药物成本。根据年龄、急性治疗与预防性治疗、流感季节和地理区域对结果进行计算和分层。结果 分析包括 2010 年至 2019 年间 1 416 764 次独特的抗病毒药物配药。奥司他韦是最常开处方的抗病毒药物 (99.8%)。每 1000 名登记儿童的配药率从 4.4 到 48.6 不等。2017 年至 2018 年流感季节期间以及中东南部地区，年龄较大的儿童（12-17 岁）的治疗率最高。流感并发症高风险幼儿（<2 岁）中符合指南的抗病毒药物使用率较低（<40%）。经通货膨胀调整后的处方费用为 208 458 979 美元，中位费用为 111 美元至 151 美元。结论 儿童流感抗病毒药物的使用存在很大差异且使用不足。这些发现揭示了改进儿童流感预防和治疗的机会。