Influenza Antiviral Treatments
INFLUENZA ANTIVIRAL TREATMENTS

• Empiric antiviral treatment is recommended as soon as possible for the following patients with suspected or confirmed influenza:

— hospitalized

— has severe, complicated, or progressive illness

— at high risk for influenza complications1

• Clinicians can consider early empiric antiviral treatment in non-high-risk outpatients with suspected influenza (eg, fever with either cough or sore throat) based upon clinical judgment if treatment can be initiated within 48hrs of illness onset.

• There are currently six FDA-approved influenza antiviral treatments in the US. Two of these, amantadine and rimantadine, are not recommended for use in the US during the 2021-2022 influenza season.

Generic Brand Strength Form Treatment Dose Prophylaxis Dose
NEURAMINIDASE INHIBITORS
oseltamivir2 Tamiflu 30mg, 45mg, 75mg caps Adults: ≥13yrs: 75mg twice daily. Renal impairment (CrCl 31–60mL/min): 30mg twice daily; (CrCl 11–30mL/min): 30mg once daily; ESRD (≤10mL/min): see full labeling.
Children: <2wks: not established. ≥2wks to <1yr: 3mg/kg twice daily. 1–12yrs: (≤15kg): 30mg twice daily; (15.1–23kg): 45mg twice daily; (23.1–40kg): 60mg twice daily; (≥40.1kg): 75mg twice daily.
Duration: 5 days
Adults: ≥13yrs: 75mg once daily. Renal impairment (CrCl 31–60mL/min): 30mg once daily; (CrCl 11–30mL/min): 30mg every other day; ESRD (≤10mL/min): see full labeling.
Children: <1yr: not established. 1–12yrs: (≤15kg): 30mg once daily; (15.1–23kg): 45mg once daily; (23.1–40kg): 60mg once daily; (≥40.1kg): 75mg once daily.
Duration: 10 days; during community outbreak: continue up to 6wks (or up to 12wks in immunocompromised)
6mg/mL pwd for oral susp
peramivir3 Rapivab 10mg/mL soln for IV inj Adults: Infuse over 15–30mins. ≥13yrs: 600mg once. Renal impairment (CrCl 30–49mL/min): 200mg once; (CrCl 10–29mL/min): 100mg once; (on hemodialysis): give after dialysis.
Children: <6mos: not established. Infuse over 15–30mins. 6mos–12yrs: 12mg/kg once; max 600mg. Renal impairment: 6mos–<2yrs (CrCl <50mL/min): no data; 2–12yrs (CrCl 30–49mL/min): 4mg/kg; (CrCl 10–29mL/min): 2mg/kg; (on hemodialysis): give after dialysis.
Duration: 1 day
Not recommended
zanamivir4 Relenza 5mg/blister dry pwd for oral inh Adults and Children: <7yrs: not established. ≥7yrs: 2 inh (10mg) twice daily ≥2hrs apart on Day 1; then 2 inh twice daily approx. 12hrs apart for the next 4 days.
Duration: 5 days
Adults and Children: <5yrs: not established. ≥5yrs: 2 inh (10mg) once daily.
Duration: Household: 10 days. Community: 28 days
POLYMERASE ACIDIC ENDONUCLEASE INHIBITOR
baloxavir marboxil5 Xofluza 20mg, 40mg tabs Adults and Children: <12yrs: not established. ≥12yrs (<80kg): 40mg once; (≥80kg): 80mg once.
Duration: 1 day
Adults and Children: <12yrs: not established. ≥12yrs (<80kg): 40mg once; (≥80kg): 80mg once.
Duration: 1 day
NOTES
1Influenza complications can include pneumonia, ear infections, sinus infections, myocarditis/pericarditis, encephalitis, aseptic meningitis, myositis, multi-organ failure, sepsis, exacerbation of chronic medical conditions (eg, CHF, COPD, asthma), etc.
2Treatment of acute, uncomplicated influenza in patients aged ≥2wks who have been symptomatic for ≤48hrs. Prophylaxis in patients aged ≥1yr.
3Treatment of acute, uncomplicated influenza in patients aged ≥6mos who have been symptomatic for ≤48hrs. Not recommended for prophylaxis.
4 Treatment of uncomplicated acute influenza in patients aged ≥7yrs who have been symptomatic for ≤48hrs. Prophylaxis in patients aged ≥5yrs. Not recommended in underlying airway disease (eg, asthma, COPD) due to risk of serious bronchospasm.
5Treatment of acute, uncomplicated influenza in patients aged ≥12yrs who have been symptomatic for ≤48hrs and who are otherwise healthy, or at high risk of developing influenza-related complications. Post-exposure prophylaxis (PEP) of influenza in patients aged ≥12yrs following contact with an individual who has influenza.
REFERENCES

Influenza Antiviral Medications: Summary for Clinicians. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm. Accessed July 20, 2021.

Created 8/2021)