Recommended Dosage and Schedule of Influenza Antiviral Medications for Treatment and Chemoprophylaxis in Children for the 2019–2020 Influenza Season: United States
| Medication . | Treatment (5 d) . | Chemoprophylaxis (10 d)a . |
|---|---|---|
| Oseltamivirb | ||
| Adults | 75 mg, twice daily | 75 mg, once daily |
| Children ≥12 mo (based on body wt) | ||
| ≤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 through 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 | 10 mg (two 5-mg inhalations), once daily |
| Children | 10 mg (two 5-mg inhalations), twice daily | 10 mg (two 5-mg inhalations), once daily |
| ≥7 y for treatment | ||
| ≥5 y for chemoprophylaxis | ||
| 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 more than 40 kg | 40–80 kg: one 40-mg dose, orally | Not recommended |
| ≥80 kg: one 80-mg dose, orally |
| Medication . | Treatment (5 d) . | Chemoprophylaxis (10 d)a . |
|---|---|---|
| Oseltamivirb | ||
| Adults | 75 mg, twice daily | 75 mg, once daily |
| Children ≥12 mo (based on body wt) | ||
| ≤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 through 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 | 10 mg (two 5-mg inhalations), once daily |
| Children | 10 mg (two 5-mg inhalations), twice daily | 10 mg (two 5-mg inhalations), once daily |
| ≥7 y for treatment | ||
| ≥5 y for chemoprophylaxis | ||
| 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 more than 40 kg | 40–80 kg: one 40-mg dose, orally | Not recommended |
| ≥80 kg: one 80-mg dose, orally |
Sources: 2018 IDSA Guidelines65 and https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm. —, not applicable.
CDC recommends for 7 days and 10 days only if part of institutional outbreak (https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm).
Oseltamivir is administered orally without regard to 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 of oral suspension, a 60-mg dose is given with 10 mL of oral suspension, and a 75-mg dose is given with 12.5 mL of 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 IDSA guidelines.65
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 a 3 mg/kg per dose, twice daily, for all infants <12 mo old; the IDSA guidelines65 include both AAP and CDC recommendations.
Oseltamivir dosing for preterm infants. The wt-based dosing recommendation for preterm infants is lower than 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 provides the basis for dosing preterm infants using their postmenstrual age (gestational age + chronologic age). For extremely preterm infants (<28 wk), please consult a pediatric infectious disease physician.
Zanamivir is administered by inhalation using a proprietary “Diskhaler” device distributed together with the medication. Zanamivir is a dry powder, not an aerosol, and should not be administered 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.