TABLE 3

Recommended Dosage and Schedule of Influenza Antiviral Medications for Treatment and Chemoprophylaxis for the 2014–2015 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 9–11 mob3.5 mg/kg per dose twice daily3.5 mg/kg per dose once daily
 Term infants 0–8 mob3 mg/kg per dose twice daily3 mg/kg per dose once daily for infants 3–8 mo; not recommended for infants <3 mo, 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 for treatment, ≥5 y for chemoprophylaxis)10 mg (two 5-mg inhalations) twice daily10 mg (two 5-mg inhalations) once daily
  • Sources: 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; 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.

  • 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), based on instructions that are present on 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, administer 75 mg, once daily, for 5 d. For chemoprophylaxis of patients with creatinine clearance 10–30 mL/min, administer 30 mg, once daily, for 10 d after exposure or 75 mg, once every other day, for 10 d after exposure (5 doses). See http://www.cdc.gov/flu/professionals/antivirals/antiviral-drug-resistance.htm.

  • 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 weight-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 full-term infants may lead to very 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 using their postmenstrual age (gestational age + 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; 3.0 mg/kg per dose, orally, twice daily, for those >40 wk postmenstrual age. For extremely premature infants (<28 wk postmenstrual age), consult a pediatric infectious disease physician.

  • d 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 with nebulizers, ventilators, or other devices typically used to administer 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.