Guidance on use of influenza antiviral medications for treatment and chemoprophylaxis, 2013-2014

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Acute Disease Service
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Phone (405) 271-4060
References:
Centers for Disease Control and Prevention Website: http://www.cdc.gov/flu/professionals/antivirals/antiviral-dosage.htm
Accessed September 24, 2013
Abbreviation: NA = not approved
* Zanamivir is manufactured by GlaxoSmithKline (Relenza --- inhaled powder). Zanamivir is approved for treatment of persons aged ≥7 years and
approved for chemoprophylaxis of persons aged ≥5 years. Zanamivir is administered through oral inhalation by using a plastic device included in
the medication package. Patients will benefit from instruction and demonstration of the correct use of the device. Zanamivir is not recommended
for those persons with underlying airway disease. Oseltamivir is manufactured by Roche Pharmaceuticals (Tamiflu --- tablet). Oseltamivir is ap-proved
for treatment of persons aged 2 weeks and older and for chemoprophylaxis of persons aged ≥1 year. Oseltamivir is available for oral
administration in 30 mg, 45 mg, and 75 mg capsules and liquid suspension. This information is based on data published by the Food and Drug
Administration (FDA).
† Recommended duration for antiviral treatment is 5 days. Longer treatment courses can be considered for patients who remain severely ill after
5 days of treatment.
§ Recommended duration of post-exposure chemoprophylaxis for high-risk patients is 7 days after the most recent known exposure if chemopro-phylaxis
can be started within 48 hours of exposure; however, early treatment if symptomatic is preferred. For control of outbreaks in long-term
care facilities and hospitals, CDC recommends antiviral chemoprophylaxis for a minimum of 2 weeks and continuing up to 1 week after the most
recent known case was identified.
¶ See the table below for information about use of oseltamivir for infants aged younger than 1 year. A reduction in the dose of oseltamivir is rec-ommended
for persons with creatinine clearance <30 mL/min.
** The treatment dosing recommendation for oseltamivir for children aged 2 weeks to younger than 1 year is 3mg/kg twice a day. The treatment
dosing recommendation for oseltamivir for children ≥1 year who weigh ≤15 kg is 30 mg twice a day. For children who weigh >15 kg to 23 kg, the
dose is 45 mg twice a day. For children who weigh >23 kg to 40 kg, the dose is 60 mg twice a day. For children who weigh >40 kg, the dose is 75
mg twice a day.
†† The chemoprophylaxis dosing recommendation for oseltamivir for children aged ≥1 year who weigh ≤15 kg is 30 mg once a day. For children
who weigh >15 kg to 23 kg, the dose is 45 mg once a day. For children who weigh >23 kg and up to 40 kg, the dose is 60 mg once a day. For
children who weigh >40 kg, the dose is 75 mg once a day.
1--6 7--9 10--12 13--64 >=65
Treatment,
inf luenza A and B
NA 10 mg (2
inhalations) twice
daily
10 mg
(2 inhalations)
twice daily
10 mg
(2 inhalations)
twice daily
10 mg
(2 inhalations) twice
daily
Antiviral agent Age group (yrs)
Zanamivir
(Relenza®)
Chemoprophylaxis,
inf luenza A and B
NA for ages
1--4
Ages 5--9
10 mg (2
inhalations) once
10 mg
(2 inhalations)
once daily
10 mg
(2 inhalations)
once daily
10 mg
(2 inhalations) once
daily
Oseltamivir¶
(Tamiflu®)
Treatment,** inf luenza
A and B
Dose varies
by child's
w eight**
Dose varies by
child's w eight**
Dose varies
by child's
w eight**
75 mg twice
daily
75 mg twice daily
Chemoprophylaxis,
inf luenza A and B
Dose varies
by child's
w eight††
Dose varies by
child's w eight††
Dose varies
by child's
w eight††
75 mg once
daily
75 mg once daily
Recommended Dosage and Schedule of Influenza Antiviral Medications* for Treatment† and Chemoprophylaxis§
Guidance on Use of Influenza Antiviral Medications for Treatment
and Chemoprophylaxis, 2013-2014
Age Recommended treatment dose for 5
days†
Recommended chemoprophylaxis dose for 10 days†
<3 mos 3 mg/kg/dose twice daily Not recommended unless situation judged critical because of
limited data on use in this age group
3--11 mos 3 mg/kg/dose twice daily 3 mg/kg/dose once daily
* An Emergency Use Authorization (EUA) was issued by the FDA on April 28, 2009 , and expired on June 23, 2010. This EUA allowed use of
oseltamivir for treatment or chemoprophylaxis of 2009 pandemic influenza A (H1N1) virus infection during the pandemic in infants aged <1 year.
Currently circulating 2009 H1N1, seasonal influenza A (H3N2), and B viruses are susceptible to oseltamivir.
† Current weight-based dosing recommendations are not appropriate for premature infants. Premature infants might have slower clearance of
oseltamivir because of immature renal function, and doses recommended for full-term infants might lead to very high drug concentrations in this
age group. Very limited data from a small cohort of premature infants suggested that oseltamivir concentrations among premature infants admin-istered
oseltamivir 1 mg/kg twice daily would be similar to those observed with the recommended treatment dose in term infants (3 mg/kg twice
daily). Observed drug concentrations were highly variable among premature infants. These data are insufficient to recommend a specific dose of
oseltamivir for premature infants.
Dosing Recommendations for Treatment or Chemoprophylaxis of Children Aged <1 Year Using Oseltamivir*