Human Influenza, Influenza
Conditions
Keywords
Oseltamivir, Tamiflu
Brief summary
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.
Interventions
DRUGOseltamivir phosphate suspension
DRUGPlacebo
Sponsors
Universidad del Valle, Guatemala
Hospital Nacional San Juan de Dios de Santa Ana, El Salvador
Hospital Nacional San Juan de Dios de San Miguel, El Salvador
Hospital Del Nino, Panama
Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Panama
Hospital Jose Domingo de Obaldia, Panama
Centers for Disease Control and Prevention
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
No minimum to 9 Years
Healthy volunteers
No
Inclusion criteria
* Age \<10 years * Accompanied by a parent or guardian who has the capacity to grant and sign the written informed consent and who has consented to enrollment * Has respiratory illness as defined by modified IMCI criteria for pneumonia: * Cough or sore throat AND Fast breathing, defined as respiratory rate 60 breaths per minutes or greater for children 0 to \<2 months, OR respiratory rate 50 breaths per minute or greater for children 2 to \<12 months, OR respiratory rate 40 breaths per minute or greater for children 12 to \<60 months, OR respiratory rate 30 breaths per minute or greater for children 5-9 years * Planned for hospital admission
Exclusion criteria
* Symptom onset 7 days or more at the time of study screening where day 1 is the day of symptom onset * Concomitant severe vomiting illness prior to enrollment that would preclude ability to take medication orally defined as more than 3 vomiting episodes in the preceding 24 hours * Prematurity (birth at less than 37 weeks gestation) for children aged less than 3 months * Birth weight less than 2500 grams for children aged less than 3 months * Chronic supplemental oxygen requirement at home * Known history of renal dysfunction * History of gastrointestinal resection resulting in gastrointestinal abnormality that might hinder absorption of oral medication (such as short-gut syndrome) * History of previous serious adverse reaction to oseltamivir phosphate * Receipt of oseltamivir phosphate during the 5 days prior to presentation at the admitting hospital * Previous enrollment in this study during a hospitalization that ended less than 14 days prior to the current admission
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Length of hospitalization | Participants will be followed for the duration of hospital stay, an expected median of 7 days | Day 1 is defined as the day of arrival at the emergency department |
| Time to resolution of increased work of breathing | Participants will be followed for the duration of hospital stay, an expected median of 7 days | 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 to resolution of hypoxia | Participants will be followed for the duration of hospital stay, an expected median of 7 days | 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 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to non-detectable influenza virus by viral culture and non-detectable influenza viral RNA by RT-PCR | 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 | — |
| Incidence of new onset respiratory failure 24 hours or more after first dose of study medication | Participants will be followed for the duration of hospital stay, an expected median of 7 days | Respiratory failure is defined by need for noninvasive or invasive mechanical ventilation |
| Proportion of participants experiencing adverse events (including severe and non-severe) | Up through 7 days after hospital discharge | 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. |
| Proportion of children with oseltamivir resistant virus detected during or after oseltamivir phosphate treatment who had oseltamivir susceptible virus infection at enrollment | 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 | — |
| Incidence of admission to intensive care unit 24 hours or more after first dose of study medication | 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 | Participants will be followed up through 7 days after hospital discharge | — |
Countries
El Salvador, Panama
Outcome results
None listed