Recommended Dosage and Schedule of Influenza Antiviral Medications for Treatment and Chemoprophylaxis in Children for the 2021–2022 Influenza Season: United States
| Medication . | Treatment . | Chemoprophylaxisa . |
|---|---|---|
| Oseltamivirb | ||
| Adults | 75 mg, twice daily for 5 d | 75 mg, once daily for 5 d |
| Children ≥12 mo (based on body wt) | Duration in all groups is 5 d | Duration in all groups is 10 d |
| ≤15 kg (≤33 lb) | 30 mg, twice daily | 30 mg, once daily |
| >15–23 kg (>33–51 lb) | 45 mg, twice daily | 45 mg, once daily |
| >23–40 kg (>51–88 lb) | 60 mg, twice daily | 60 mg, once daily |
| >40 kg (>88 lb) | 75 mg, twice daily | 75 mg, once daily |
| Infants 9–11 moc | 3.5 mg/kg per dose, twice daily | 3.5 mg/kg per dose, once daily |
| Term infants 0–8 moc | 3 mg/kg per dose, twice daily | 3 mg/kg per dose, once daily for infants 3–8 mo; not recommended for infants <3 mo old because of limited safety and efficacy data in this age group |
| Preterm infantsd | ||
| <38 wk postmenstrual age | 1.0 mg/kg per dose, twice daily | — |
| 38–40 wk postmenstrual age | 1.5 mg/kg per dose, twice daily | — |
| >40 wk postmenstrual age | 3.0 mg/kg per dose, twice daily | — |
| Zanamivire | ||
| Adults | 10 mg (two 5-mg inhalations), twice daily for 5 d | 10 mg (two 5-mg inhalations), once daily for 10 d |
| Children (≥7 y for treatment, ≥5 y for chemoprophylaxis) | 10 mg (two 5-mg inhalations), twice daily for 5 d | 10 mg (two 5-mg inhalations), once daily for 10 d |
| Peramivir | ||
| Adults | One 600-mg IV infusion, given over 15–30 min | Not recommended |
| Children (2–12 y) | One 12 mg/kg dose, up to 600 mg maximum, via IV infusion for 15–30 min | Not recommended |
| Children (13–17 y) | One 600 mg dose, via IV infusion for 15–30 min | Not recommended |
| Baloxavir | ||
| People ≥12 y who weigh >40 kg | 40–80 kg: one 40-mg dose, orally | 40–80 kg: one 40-mg dose, orally |
| ≥80 kg: one 80-mg dose, orally | ≥80 kg: one 80-mg dose, orally |
| Medication . | Treatment . | Chemoprophylaxisa . |
|---|---|---|
| Oseltamivirb | ||
| Adults | 75 mg, twice daily for 5 d | 75 mg, once daily for 5 d |
| Children ≥12 mo (based on body wt) | Duration in all groups is 5 d | Duration in all groups is 10 d |
| ≤15 kg (≤33 lb) | 30 mg, twice daily | 30 mg, once daily |
| >15–23 kg (>33–51 lb) | 45 mg, twice daily | 45 mg, once daily |
| >23–40 kg (>51–88 lb) | 60 mg, twice daily | 60 mg, once daily |
| >40 kg (>88 lb) | 75 mg, twice daily | 75 mg, once daily |
| Infants 9–11 moc | 3.5 mg/kg per dose, twice daily | 3.5 mg/kg per dose, once daily |
| Term infants 0–8 moc | 3 mg/kg per dose, twice daily | 3 mg/kg per dose, once daily for infants 3–8 mo; not recommended for infants <3 mo old because of limited safety and efficacy data in this age group |
| Preterm infantsd | ||
| <38 wk postmenstrual age | 1.0 mg/kg per dose, twice daily | — |
| 38–40 wk postmenstrual age | 1.5 mg/kg per dose, twice daily | — |
| >40 wk postmenstrual age | 3.0 mg/kg per dose, twice daily | — |
| Zanamivire | ||
| Adults | 10 mg (two 5-mg inhalations), twice daily for 5 d | 10 mg (two 5-mg inhalations), once daily for 10 d |
| Children (≥7 y for treatment, ≥5 y for chemoprophylaxis) | 10 mg (two 5-mg inhalations), twice daily for 5 d | 10 mg (two 5-mg inhalations), once daily for 10 d |
| Peramivir | ||
| Adults | One 600-mg IV infusion, given over 15–30 min | Not recommended |
| Children (2–12 y) | One 12 mg/kg dose, up to 600 mg maximum, via IV infusion for 15–30 min | Not recommended |
| Children (13–17 y) | One 600 mg dose, via IV infusion for 15–30 min | Not recommended |
| Baloxavir | ||
| People ≥12 y who weigh >40 kg | 40–80 kg: one 40-mg dose, orally | 40–80 kg: one 40-mg dose, orally |
| ≥80 kg: one 80-mg dose, orally | ≥80 kg: one 80-mg dose, orally |
Adapted from Uyeki TM, Bernstein HH, Bradley JS, et al. Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza [published correction appears in Clin Infect Dis. 2019;68(10):1790]. Clin Infect Dis. 2019;68(6):e1–e47; and https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm. —, not applicable.
The CDC recommends routine chemoprophylaxis with oseltamivir or zanamivir for 7 d and for 10 d only if part of an institutional outbreak (https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm).
The duration of treatment with oseltamivir is 5 d. Oseltamivir is administered orally regardless of meals, although administration with meals may improve gastrointestinal tolerability. Oseltamivir is available as Tamiflu in 30-, 45-, and 75-mg capsules and as a powder for oral suspension that is reconstituted to provide a final concentration of 6 mg/mL. For the 6-mg/mL suspension, a 30-mg dose is given with 5 mL of oral suspension, a 45-mg dose is given with 7.5 mL oral suspension, a 60-mg dose is given with 10 mL oral suspension, and a 75-mg dose is given with 12.5 mL oral suspension. If the commercially manufactured oral suspension is not available, a suspension can be compounded by retail pharmacies (final concentration also 6 mg/mL) on the basis of instructions contained in the package label. In patients with renal insufficiency, the dose should be adjusted on the basis of creatinine clearance. For treatment of patients with creatinine clearance 10–30 mL/min: 75 mg once daily for 5 d. For chemoprophylaxis of patients with creatinine clearance 10–30 mL/min: 30 mg once daily for 10 d after exposure or 75 mg, once every other day, for 10 d after exposure (5 doses). See https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm and Infectious Diseases Society of America guidelines.88
Approved by the FDA for children as young as 2 wk of age. Given preliminary pharmacokinetic data and limited safety data, oseltamivir can be used to treat influenza in both term and preterm infants from birth because benefits of therapy are likely to outweigh possible risks of treatment. Of note, the CDC recommends 3 mg/kg per dose twice daily for all infants <12 mo old; the Infectious Diseases Society of America guidelines88 include both AAP and CDC recommendations.
Oseltamivir dosing for preterm infants: the wt-based dosing recommendation for preterm infants is lower than that for term infants. Preterm infants may have lower clearance of oseltamivir because of immature renal function, and doses recommended for term infants may lead to high drug concentrations in this age group. Limited data from the National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group provide the basis for dosing preterm infants by using their postmenstrual age (gestational age + chronological age). For extremely preterm infants (<28 wk), please consult a pediatric infectious disease physician.
The duration of treatment with zanamivir is 5 d. Zanamivir is administered by inhalation by using a proprietary “Diskhaler” device distributed together with the medication. Zanamivir is a dry powder, not an aerosol, and should not be administered by using nebulizers, ventilators, or other devices typically used for administering medications in aerosolized solutions. Zanamivir is not recommended for people with chronic respiratory diseases, such as asthma or chronic obstructive pulmonary disease, which increase the risk of bronchospasm.