© 2014 The Korean Academy of Medical Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. pISSN 1011-8934 eISSN 1598-6357 he Association between Inluenza Treatment and Hospitalization-Associated Outcomes among Korean Children with Laboratory-Conirmed Inluenza There are limited data evaluating the relationship between influenza treatment and hospitalization duration. Our purpose assessed the association between different treatments and hospital stay among Korean pediatric influenza patients. Total 770 children ≤ 15 yr-of-age hospitalized with community-acquired laboratory-confirmed influenza at three large urban tertiary care hospitals were identified through a retrospective medical chart review. Demographic, clinical, and cost data were extracted and a multivariable linear regression model was used to assess the associations between influenza treatment types and hospital stay. Overall, there were 81% of the patients hospitalized with laboratory-confirmed influenza who received antibiotic monotherapy whereas only 4% of the patients received oseltamivir monotherapy. The mean treatment-related charges for hospitalizations treated with antibiotics, alone or with oseltamivir, were significantly higher than those treated with oseltamivir-only ( P < 0.001). Influenza patients treated with antibiotics-only and antibiotics/oseltamivir combination therapy showed 44.9% and 28.2%, respectively, longer duration of hospitalization compared to those treated with oseltamivir-only. Patients treated with antibiotics, alone or combined with oseltamivir, were associated with longer hospitalization and significantly higher medical charges, compared to patients treated with oseltamivir alone. In Korea, there is a need for more judicious use of antibiotics, appropriate use of influenza rapid testing. Keywords: Influenza, Human; Hospitalizations; Oseltamivir; Therapeutics; Child Jacqueline K. Lim, 1 Tae Hee Kim, 2 Paul E. Kilgore, 3 Allison E. Aiello, 4 Byung Min Choi, 5 Kwang Chul Lee, 5 Kee Hwan Yoo, 5 Young-Hwan Song, 6 and Yun-Kyung Kim 5 1 International Vaccine Institute, Seoul; 2 Department of Pediatric Pulmonology & Allergy, Asan Medical Center, Seoul, Korea; 3 Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI; 4 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA; 5 Department of Pediatrics, College of Medicine, Korea University, Seoul; 6 Department of Pediatrics, Inje College of Medicine, Seoul, Korea Received: 18 August 2013 Accepted: 26 February 2014 Address for Correspondence: Yun-Kyung Kim, MD Department of Pediatrics, College of Medicine, Korea University, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 425-707, Korea Tel: +82.10-2248-2330, Fax: +82.31-403-5891 E-mail: byelhana@korea.ac.kr This study was supported by funding from the Korean Center for Disease Control and Prevention (grant #: 2007-S2-E-003), as well as from the governments of Kuwait, Sweden, and the Republic of Korea. http://dx.doi.org/10.3346/jkms.2014.29.4.485 • J Korean Med Sci 2014; 29: 485-493 INTRODUCTION Influenza viruses are common respiratory pathogens among all age groups and are major causes of excess respiratory dis- ease-associated hospitalizations, mortality, and costs during annual epidemics and pandemics (1, 2). Children with under- lying medical conditions and younger age, especially ≤ 5 yr olds, are at high risk for severe inluenza-associated outcomes (3-5). Furthermore, pediatric influenza exerts a considerable socioeconomic burden in terms of direct and indirect costs, and excess health-care utilization (6-8). Children also serve as a reservoir for household transmission of inluenza, causing sec- ondary illness in the family (8, 9). Currently available neuraminidase inhibitors are efective in reducing inluenza-associated illness duration, severity, com- plication risks, inluenza-related mortality and even antibiotic use (10-12). Often patients hospitalized with inluenza-related illnesses are inappropriately treated with antibiotics as prophy- lactic and empiric therapy, as indicated by increased antibiotic prescriptions during the inluenza season (10, 13). he emer- gence of drug resistance and over-prescription of antibiotics are growing public health issues, as well as increased healthcare costs without reductions in illness duration (14-16). Republic of Korea (ROK) has a relatively high inluenza vac- cination coverage rate of nearly 40% in the general population (17) and this is higher than the vaccination rate among children hospitalized with acute respiratory infection in the US (18) and similar to that of healthy Ontario children in Canada (19). None- theless, Korea still sufers from considerable disease burden of inluenza in chi ldren, where 20% of viral respiratory disease hos- ORIGINAL ARTICLE Infectious Diseases, Microbiology & Parasitology