Updated Meta-Analysis Comparing the Therapeutic Efficacy of Oseltamivir and Baloxavir in Children With Influenza

Influenza is an acute viral respiratory infection with wide seasonal circulation, whose clinical presentation ranges from self-limited illness to severe systemic complications. Children are a well-established risk group, often presenting with persistent fever and requiring hospitalization. Oseltamivir remains the reference antiviral for treatment. However, baloxavir marboxil has emerged as a promising therapeutic alternative, standing out for its single-dose regimen and differentiated mechanism of action. Nevertheless, evidence regarding its efficacy compared with oseltamivir in the pediatric population remains limited, particularly for objective clinical outcomes such as fever duration. To compare the mean duration of fever in children with influenza treated with baloxavir marboxil versus oseltamivir. A systematic search was conducted in PubMed, EMBASE, and the Cochrane Library through June 18, 2024, including randomized clinical trials and observational studies comparing baloxavir and oseltamivir in children. Screening, extraction, and statistical analysis were performed by two independent reviewers, using a random-effects model in RevMan Web (v. 8.0.0), with mean difference and 95% CI as the effect measure for fever duration. Among 200 identified references, seven studies met eligibility criteria (two randomized clinical trials and five observational studies), totaling 3,241 participants, of whom 1,318 (40.7%) received baloxavir. In the pooled analysis, baloxavir significantly reduced fever duration compared with oseltamivir (mean difference −10.31 hours; 95% CI −18.10 to −2.51; p = 0.010; I² = 99%). In the influenza A (H1N1) subgroup, a consistent benefit was observed, with a reduction of 8.42 hours (95% CI −12.65 to −4.20; p < 0.0001; I² = 0%). In contrast, in the influenza A (H2N3) subgroup, no statistically significant difference was found between antivirals (mean difference −0.25 hours; 95% CI −5.31 to 4.80; p = 0.92; I² = 0%). Baloxavir was associated with shorter fever duration, particularly in H1N1 infections. However, no statistically significant differences were observed for the H3N2 strain, indicating the need for additional studies to validate these findings.