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 2022-2023 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)
oseltamivir²	Tamiflu	6mg/mL	pwd for oral susp
peramivir³	Rapivab	10mg/mL	soln for IV infusion	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 once; (CrCl 10–29mL/min): 2mg/kg once; (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	40mg, 80mg	tabs	Adults and Children: <5yrs, <12yrs (high risk of developing influenza-related complications): not established. ≥5yrs: (20–<80kg): 40mg once; (≥80kg): 80mg once. Duration: 1 day	Adults and Children: <5yrs: not established. ≥5yrs: (20–<80kg): 40mg once; (≥80kg): 80mg once. Duration: 1 day
NOTES
¹ Influenza 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. ² Treatment of acute, uncomplicated influenza in patients aged ≥2wks who have been symptomatic for ≤48hrs. Prophylaxis in patients aged ≥1yr. ³ Treatment 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. ⁵ Treatment of acute, uncomplicated influenza in patients who have been symptomatic for ≤48hrs in patients aged ≥5yrs who are otherwise healthy, or aged ≥12yrs who are at high risk of developing influenza-related complications. Post-exposure prophylaxis of influenza in patients aged ≥5yrs following contact with an individual who has influenza.
REFERENCE
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 January 18, 2023. (Rev. 1/2023)

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