TABLE 5

Recommended Dosage and Schedule of Influenza Antiviral Medications for Treatment and Chemoprophylaxis in Children for the 2018–2019 Influenza Season: United States

MedicationTreatment (5 d)Chemoprophylaxis (10 d)
Oseltamivira
 Adults75 mg twice daily75 mg once daily
 Children ≥12 mo
  Body wt
   ≤15 kg (≤33 lb)30 mg twice daily30 mg once daily
   >15–23 kg (33–51 lb)45 mg twice daily45 mg once daily
   >23–40 kg (>51–88 lb)60 mg twice daily60 mg once daily
   >40 kg (>88 lb)75 mg twice daily75 mg once daily
 Infants ages 9–11 mob3.5 mg/kg per dose twice daily3.5 mg/kg per dose once daily
 Term infants ages 0–8 mob3 mg/kg per dose twice daily3 mg/kg per dose once daily for infants 3–8 mo old; not recommended for infants <3 mo old unless situation judged critical because of limited safety and efficacy data in this age group
 Preterm infantsSee details in footnotec
Zanamivird
 Adults10 mg (two 5 mg inhalations) twice daily10 mg (two 5 mg inhalations) once daily
 Children (≥7 y old for treatment; ≥5 y old for chemoprophylaxis)10 mg (two 5 mg inhalations) twice daily10 mg (two 5 mg inhalations) once daily
Peramivir
 Adults600 mg intravenous infusion once given over 15–30 min
 Children (2–12 y old)One 12 mg/kg dose, up to 600 mg maximum, via intravenous infusion for 15–30 min
 Children (13–17 y old)One 600 mg dose via intravenous infusion for 15–30 min
  • Adapted from Centers for Disease Control and Prevention. Antiviral agents for the treatment and chemoprophylaxis of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(RR–1):1–24; and Kimberlin DW, Acosta EP, Prichard MN, et al; National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Oseltamivir pharmacokinetics, dosing, and resistance among children aged <2 y with influenza. J Infect Dis. 2013;207(5):709–720. — indicates not applicable.

  • a Oseltamivir is administered orally without regard to meals, although administration with meals may improve gastrointestinal tolerability. Oseltamivir is available as Tamiflu in 30 mg, 45 mg, 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 the treatment of patients with creatinine clearance 10 to 30 mL per min: 75 mg once daily for 5 days. For the chemoprophylaxis of patients with creatinine clearance 10 to 30 mL per min: 30 mg once daily for 10 days after exposure or 75 mg once every other day for 10 days after exposure (5 doses).

  • b 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.

  • c 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 provide the basis for dosing preterm infants by using their postmenstrual age (gestational age plus chronological age): 1.0 mg/kg per dose orally twice daily for those <38 wk postmenstrual age; 1.5 mg/kg per dose orally twice daily for those 38 through 40 wk postmenstrual age; and 3.0 mg/kg per dose orally twice daily for those >40 wk postmenstrual age. For extremely preterm infants (<28 wk), please consult a pediatric infectious diseases physician.

  • 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.