Influenza (<18 years old)
Influenza (<18 years old)

Influenza Treatment and Prophylaxis:

Drug & Class

Age

Treatment Dosing

Prophylaxis Dosing

Notes

Adverse Reactions

Oral oseltamivir (Tamiflu ®) - neuraminidase inhibitors

≥2 weeks

5 days of treatment.

<1 yr old:3 mg/kg/dose twice daily

≥1 yr old:

15 kg or less, the dose is 30 mg twice a day>15 to 23 kg, the dose is 45 mg twice a day>23 to 40 kg, the dose is 60 mg twice a day>40 kg, the dose is 75 mg twice a day

7 days of prophylaxis.

3 months or older and younger than 1 yr old: 3 mg/kg/dose once daily

>1 yr old:

15 kg or less, the dose is 30 mg once a day>15 to 23 kg, the dose is 45 mg once a day>23 to 40 kg, the dose is 60 mg once a day>40 kg, the dose is 75 mg once a day

Antiviral of choice in children

Nausea, vomiting, headache.

Inhaled zanamivir (Relenza ®) - neuraminidase inhibitors

≥7 years

5 days of treatment.

10 mg (two 5-mg inhalations) twice daily

7 days of prophylaxis.

10 mg (two 5-mg inhalations) once daily

Avoid in patients with underlying respiratory disease.

Bronchospasm, especially in the setting of underlying airways disease; sinusitis, and dizziness.

Intravenous peramivir (Rapivab ®) - neuraminidase inhibitors

≥2 years

1 day of treatment.

One 12 mg/kg dose, up to 600 mg maximum, via intravenous infusion for a minimum of 15 minutes.

Not recommended.

Diarrhea.

Oral baloxavir (Xofluza ®) - selective inhibitor of influenza cap-dependent endonuclease

≥12 years

1 day of treatment.

40 to <80 kg: One 40 mg dose

>80 kg: One 80 mg dose

Not recommended.

None more common than placebo in clinical trials.

(Dosing and adverse events adopted from the CDC tables found here: https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm#Table1)

Test for presumed influenza infection and initiate antiviral treatment. Do not withhold treatment while awaiting test results if high clinical suspicion for influenza.

Oseltamivir suspension
Influenza Test

The testing for and treatment of influenza can be considered for previously healthy, symptomatic patients with fewer than 48 hours of symptoms. Do not withhold treatment while awaiting test results if high clinical suspicion for influenza.

Oseltamivir suspension
Influenza Test
Inclusion Criteria
  • <18 years old
  • Concern for influenza infection or exposure
Exclusion Criteria
  • Unstable or toxic appearing

Requires admission to the hospital?

Severe, complicated, or progressive illness with suspected or confirmed influenza?

Previously healthy symptomatic patient with confirmed or suspected flu and <48 hours of symptoms?

<48 hours since laboratory-confirmed influenza exposure?

Postexposure prophylaxis is not indicated if exposure was more than 48 hours prior. The IDSA and CDC recommend watching for symptoms and follow up for treatment dose antivirals if symptoms arise.

Is the patient a) high risk or b) living with someone who is high risk? (see “High Risk Patients” list)

Postexposure prophylaxis is not indicated if exposed is not high-risk or living in a household with others at high-risk of influenza complications.

Did the patient receive the influenza vaccine this season?

Offer inactivated influenza vaccine (injection).

Is the patient a) high risk or b) living with someone who is high risk? (see “High Risk Patients” list to left)

Current Influenza Activity

Prescribe 7-day course of antiviral prophylaxis. Recommend follow up for treatment dosing if symptoms arise.

Oseltamivir suspension

Influenza Symptoms:

  • Abrupt onset of fever with headache, diffuse myalgias, and/or malaise.
  • Can develop respiratory tract infection with sore throat, cough, congestion, and/or rhinitis.
  • Younger children may present with fever and febrile seizure.
  • Younger children also tend to have more gastrointestinal symptoms (nausea, vomiting, diarrhea) and fewer respiratory symptoms.

High Risk Patients

  • Patients at high risk of complications from an influenza infection.
  • Children <2 years.
  • Adults >50 years and especially those ≥65 years.
  • People with chronic pulmonary disease (e.g., asthma, cystic fibrosis) or impaired respiratory function (including tracheostomy and mechanical ventilation); significant cardiovascular disease; renal, hepatic, or hematologic disease (e.g., sickle cell); or metabolic or endocrine disorders (including diabetes mellitus).
  • Immunocompromised patients.
  • Patients with neurologic or neurodevelopment conditions such as cerebral palsy, epilepsy, stroke, intellectual disability, developmental delay, muscular dystrophy, spinal cord injury.
  • Women pregnant or postpartum (within 2 weeks of delivery).
  • Children on long-term aspirin therapy to decrease the risk of Reye syndrome.
  • Patients with extreme obesity (i.e., BMI ≥40 for adults).
  • American Indian and Alaska Natives.

Testing and treatment of previously healthy patients who have been symptomatic for >48 hours and are neither high risk themselves nor living with someone who is high risk, are not recommended by the CDC or AAP given limited benefit of antiviral treatment after 48 hours. Recommend follow up as needed for worsening or new concerning symptoms.

Newborn Mothers with Influenza

  • Strongly encourage breastfeeding or feeding expressed or pumped breast milk to infant.
  • Consider separation of newborn and mother.
  • The mother can be treated with oseltamivir – the antiviral of choice in breastfeeding mothers.

Differential Diagnosis:

  • Other respiratory viruses including respiratory syncytial virus, parainfluenza virus, adenovirus, rhinovirus, and enterovirus.
  • Bacterial infections including pneumonia, pharyngitis, rhinosinusitis.

Influenza Vaccination

  • The influenza vaccine is recommended for all persons ≥6 months of age who do not have a contraindication. Vaccination is especially encouraged for high-risk patients and those taking care of or living with high-risk patients (see High-Risk Patients list).

If the patient requires hospitalization, sending PCR testing for influenza and initiate antiviral treatment with oseltamivir.

Admit to Floor
Oseltamivir suspension
Influenza Test



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