Influenza Treatment Guidelines

Primary Treatment Approach

The American Academy of Pediatrics and the Infectious Diseases Society of America recommend oral oseltamivir as the antiviral of choice for all hospitalized patients with severe influenza, regardless of illness duration prior to hospitalization 1, 2, 3, 4
Treatment should begin as soon as possible for any hospitalized patient with documented or suspected influenza, even beyond 48 hours of symptom onset 1, 2
Inhaled zanamivir is an acceptable alternative for patients ≥7 years without chronic respiratory disease, though more difficult to administer 3, 4

The FDA approves peramivir only for acute uncomplicated influenza in non-hospitalized patients ≥6 months who have been symptomatic ≤2 days 6, 3, 4
The efficacy of peramivir in patients with serious influenza requiring hospitalization has not been established 6, 3, 4

For pediatric patients (6 months to 12 years), the recommended dose is 12 mg/kg (maximum 600 mg) as a single IV infusion over 15-30 minutes 6
For adult patients, the recommended dose is 600 mg as a single IV infusion over 15-30 minutes 6, 1

Consider extending oseltamivir beyond 5 days for immunocompromised patients with documented or suspected persistent viral replication, severe lower respiratory tract disease, or evidence of ongoing viral shedding after 7-10 days 1, 2
Empirically treat bacterial coinfection in addition to antivirals when patients present with extensive pneumonia, respiratory failure, hypotension, and fever at initial presentation 1, 2

Do not delay treatment waiting for test results—start empirically in hospitalized patients with suspected influenza 1, 2
Do not use peramivir as first-line therapy when oral oseltamivir can be administered 3, 4, 5
Do not assume IV route is superior—no evidence supports this for influenza 1, 2

Instruct patients to seek emergency care for shortness of breath, painful or difficult breathing, bloody sputum, drowsiness, disorientation, or confusion 7, 6