Two Studies Confirm Flu Antivirals Cut Hospitalization and ICU Risk in Kids, But Use Keeps Dropping

Two studies published in August 2026 make the same basic point from different angles: giving kids antivirals for the flu works, and doctors are prescribing them less than they used to.

The first, published in Pediatrics and led by Chi-Tai Fang, MD, PhD, of National Taiwan University, looked at 1,492 children treated as outpatients. Kids who got antiviral therapy within 48 hours of symptom onset had an 81% lower risk of flu-related hospitalization, according to the study (adjusted odds ratio 0.19). That protection held up whether the kid was 5 or younger or older, which matters because young children are the ones most likely to end up in serious trouble.

The second study, published August 10, 2026, in JAMA Pediatrics and led by Suchitra Rao, MD, of the University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, looked at a different population: over 7,000 children already hospitalized with confirmed flu across 13 states and eight flu seasons, using CDC-supported surveillance data from FluSurv-NET. Kids treated with oseltamivir (brand name Tamiflu) were 31% less likely to need ICU care. Early treatment, within two days of hospital admission, cut ICU risk 26%. Late treatment cut it 45%. Treated kids also spent less time in the hospital, an average of 3.3 days versus 3.7 days for untreated kids, a difference of 9.4 hours.

The second finding is the more surprising one. Standard guidance says antivirals work best within 48 hours of symptoms starting. Rao's data suggests benefit even when treatment starts later than that. "Our findings show that oseltamivir treatment can decrease the risk of needing critical care, even if started beyond the first two days of the start of the illness," Rao said in a university news release.

What's new is the data quality. Rao's team specifically noted that earlier studies were weakened by not knowing exactly when symptoms started or whether kids got antivirals before they were even hospitalized. This study tracked that timeline more precisely, which is why the researchers call it stronger real-world evidence.

Usage is falling anyway. CDC surveillance data cited in the Colorado study shows 63% of children hospitalized with flu during the 2024-2025 season received antivirals. In the 2017-2018 season, that number was 86%. That's a 23-point drop in prescribing among hospitalized kids, the population where national guidelines most clearly call for treatment, according to the CDC data referenced by researchers.

On the outpatient side, the numbers look worse. A nationwide survey of US clinicians, cited by Fang's team in Pediatrics, found fewer than half of respondents said they'd prescribe oseltamivir for kids with the flu outside the hospital. That's despite recommendations from the World Health Organization, the Infectious Diseases Society of America, the CDC, and the American Academy of Pediatrics, all of which call for prompt antiviral treatment in kids at elevated risk, including those under 2 and those with underlying health conditions.

James Antoon, MD, PhD, and Kathryn Edwards, MD, both of Vanderbilt University Medical Center, wrote an editorial in Pediatrics accompanying the Taiwan study calling the moment out directly. "With greater public hesitancy regarding vaccines, declining seasonal influenza vaccination rates, and recent influenza seasons with record pediatric deaths and hospitalizations, providers should strongly consider the use of antivirals in high-risk and hospitalized patients," they wrote. "The time has come for antivirals to be used in children with influenza."

Antoon and Edwards also flagged benefits beyond keeping kids out of hospitals: less household spread of flu, fewer complications, and a faster return to school and work for families. Families deal with these costs every flu season, though they rarely get weighed against the drug's modest side-effect profile.

Both studies are observational, not randomized controlled trials. Stephen Tomlin, professional lead of the UK's Neonatal and Paediatric Pharmacy Group, acknowledged this limitation directly: the design "cannot prove cause and effect in the same way as a randomised controlled trial," though he called the Colorado study's methods "robust" and the results "one of the strongest real-world studies we've seen." Correlation between getting a prescription and better outcomes could theoretically reflect other factors, like which families have easier access to care in the first place. Researchers on both teams used statistical adjustments to try to account for that, but it's not the same as a blinded trial.

Fang and colleagues were explicit that antivirals are a supplement to vaccination, not a replacement, particularly important for infants under 6 months who aren't eligible for flu shots at all.