Comment: The quality of evidence is downgraded by imprecise results (few patients for each comparison).
A Cochrane review included 6 studies with a total of 2356 children, of whom 1255 had laboratory-confirmed influenza.
Oseltamivir reduced the median duration of illness by 26% (36 hours) in previously healthy children with laboratory confirmed influenza and by 17% (21 hours) in the intention-to-treat population. The reduction was only 7.7% (10 hours) in 'at risk' (asthmatic) children (no statistical significance). In one RCT studying oseltamivir in the prevention of influenza transmission in households (222 paediatric contacts), a protective efficacy of 55% was observed when the index cases had laboratory-confirmed influenza (no statistical significance). Zanamivir reduced the median duration of illness by 24% (1.25 days) in previously healthy children with laboratory confirmed influenza and by 10% (0.5 days) in the intention-to-treat population. Only oseltamivir produced a significant reduction in the complications of influenza (particularly otitis media), although there was a trend to benefit for zanamivir.In children with laboratory-confirmed influenza oseltamivir reduced median duration of illness by 36 hours (26%). Zanamivir reduced median duration of illness by 1.3 days (24%). Oseltamivir significantly reduced acute otitis media in children aged one to five years with laboratory-confirmed influenza (risk difference (RD) -0.14, 95% CI -0.24 to -0.04). Prophylaxis with either zanamivir or oseltamivir was associated with an 8% absolute reduction in developing influenza after the introduction of a case into a household (RD -0.08, 95% CI -0.12 to -0.05). The adverse event profile of zanamivir was no worse than placebo but vomiting was more commonly associated with oseltamivir (number needed to harm = 17, 95% CI 10 to 34).