I am working as Senior Pediatrician in Corporation
hospital with indoor capacity of 750 beds out of which 90 beds are for
pediatric patients, including NICU and PICU. At present we are coming
across many patients receiving fluvir (oseltamivir) for ILI (Influenza
like illness) and then referred to our hospital. Most of these patients
suffer from cough, coryza, breathlessness and bronchospasm. According to
government guidelines, fluvir is to be given for Category A, which include
ILI with seriously ill patients requiring life saving measures and
Category B, children with fever >38°C, tachy-pnea, cough and coryza,
breathlessness with or without loose motions and vomiting. We come across
similar complaints very often and we treat them as bronchiolitis/reactive
airway disease. Are we justified in using oseltamivir so often, knowing
the limitations and side effects of oseltamivir. Should there not be
separate guidelines for starting oseltamivir in children, especially <2
years of age?
In our hospital, uptil now, out of 16 suspected H1N1
patients who were receiving fluvir from outside, only 2 turned out to be
H1N1 swab positive and these children recovered rapidly with oxygen, IV
fluids, and nebulization within 24 hours without any radiological evidence
of pneumonia.