The Australian Living Evidence Collaboration (ALEC) last week published a guideline providing interim advice on drug treatments for people with influenza who are critically ill. Development of the guideline was triggered by a recent preliminary trial result that suggested oseltamivir, the current first-line treatment for influenza in people who are critically ill, is not effective and may be harmful in adult patients with influenza in critical care.
Professor Allen Cheng, Professor of Infectious Diseases at Monash University and Program Director, Medical Specialties at Monash Health, and member of the Guidelines Leadership Group writes, “It’s particularly important now as we are about to enter the influenza season – while there haven’t been many influenza admissions so far this year, we expect that we will start to see more cases over the coming months.” Professor Cheng adds, “The study hasn’t yet been published, although preliminary results have been made public. The guideline details down what we actually want clinicians to do.”
As an integral contributor to ALEC’s COVID-19 guidelines from 2020-2023, Professor Cheng understands the need for clinical guidance during uncertain times, “The National COVID-19 Clinical Evidence Taskforce was an important way to update clinicians on the constantly changing landscape of evidence about treatments. Although obviously the treatment of influenza in critically ill patients is not quite as quickly moving an area, it is important that we work out what this study means to practice, and these guidelines are the most rigorous and timely way to do this.”
The trial results in adults prompted questions about drug treatments for children with influenza who are critically ill. Dr Simon Erickson, Paediatric Intensive Care Physician at Perth Children’s Hospital, was quick to join the Paediatric Clinical Panel to address people’s concerns. “Having worked in paediatric critical care for many years and seeing the devastating impact that influenza can cause in some cases, I wanted to contribute to these guidelines in the hope of helping my colleagues in acute paediatric care to be able to give children with severe influenza the best care possible.”
When asked about the importance of this guideline at this time, Dr Erickson replied, “Influenza can be a very serious disease, even in previously healthy children. Influenza can result in devastating respiratory, neurological and cardiac disease and can lead to mortality and serious morbidity in critically ill children. This guideline will be essential in standardizing the management of critical influenza in children and improving outcomes.”
Professor Sandra Peake, Senior Critical Care Physician at The Queen Elizabeth Hospital in South Australia, writes of the importance of expert input into guideline development, “My clinical practice is guided by the best available evidence. I felt that I was able to critically appraise the recent evidence regarding oseltamivir and could contribute in a meaningful way to developing a national guideline that would inform other clinicians caring for the critically ill.”
Professor Peake adds a key consideration for all users of the guideline, “Guidelines provide clinicians at the bedside with clear, actionable recommendations for how best to care for their patients. Importantly, however, whilst guidelines can facilitate the rapid uptake of new information, they should only be adopted alongside clinical judgement based on individual patient factors and local resources.”
The Australian guideline Drug treatments for people with influenza who are critically ill is now open for public consultation until 8 August 2026. We welcome your feedback on the recommendations and supporting information to ensure it is useful for intended users.
