TABLE 4

Recommended Dosage and Schedule of Influenza Antiviral Medications for Treatment and Chemoprophylaxis for the 2012–2013 Influenza Season: United States

MedicationTreatment (5 d)Chemoprophylaxis (10 d)
Oseltamivira
Adults75 mg twice daily75 mg once daily
Children >12 mo
Body weight
 ≤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 twice daily
 >40 kg (>88 lb)75 mg twice daily75 mg once daily
 Children 3 mo to <12 mob3 mg/kg/dose twice daily3 mg/kg/dose once per day
 Children 0 to <3 moc3 mg/kg/dose twice dailyNot recommended unless situation judged critical (because of limited data on use in this age group)
Zanamivird
 Adults10 mg (two 5-mg inhalations) twice daily10 mg (two 5-mg inhalations) once daily
 Children (≥7 y for treatment, ≥5 y for chemoprophylaxis10 mg (two 5-mg inhalations) twice daily10 mg (two 5-mg inhalations) once daily
  • Source: Fiore AE, Fry A, Shay D, Gubareva L, Bresee JS, Uyeki TM; Centers for Disease Control and Prevention (CDC). Antiviral agents for the treatment and chemoprophylaxis of influenza—recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(1):1–24.

  • a Oseltamivir is manufactured by Roche Pharmaceuticals and 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 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, the capsules may be opened and the contents mixed with a sweetened liquid to mask the bitter taste, or a suspension can be compounded by retail pharmacies (final concentration: 15 mg/mL), based on instructions that are present in the package label. In patients who have renal insufficiency, the dose should be adjusted on the basis of creatinine clearance. For treatment of patients with creatinine clearance 10 to 30 mL/min: 75 mg once daily for 5 days. For chemoprophylaxis of patients with creatinine clearance 10 to 30 mL/min: 30 mg, once daily, for 10 days after exposure or 75 mg, once every other day, for 10 days after exposure (5 doses). See http://www.cdc.gov/flu/professionals/antivirals/antiviral-drug-resistance.htm.

  • b Weight-based dosing is required. Although the Emergency Use Authorization recommendations for use of oseltamivir in children aged <1 year expired on June 23, 2010, the AAP continues to recommend use of this drug when indicated because no other therapy is currently available for this highly vulnerable age group.

  • c This weight-based dosing recommendation is not intended for preterm infants. Preterm infants may have slower 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. Very limited data from 2 cohorts of preterm infants receiving an average dose of 1.0 mg/kg twice daily demonstrated drug concentrations that approximated those observed with the recommended treatment dose in term infants (3 mg/kg twice daily). However, observed drug concentrations were highly variable among preterm infants.

  • d Zanamivir is manufactured by GlaxoSmithKline and 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 who have chronic respiratory diseases such as asthma or chronic obstructive pulmonary disease that increase the risk of bronchospasm.