Treatment of Influenza in Children

Introduction to Antiviral Treatment

The American Academy of Pediatrics recommends oral oseltamivir as the antiviral drug of choice for treating influenza in children, and should be initiated immediately in all hospitalized children with suspected influenza, children with severe or progressive illness, and children at high risk for complications—regardless of vaccination status or time since symptom onset 1, 2.

The American Academy of Pediatrics recommends that treatment should be offered as early as possible to any hospitalized child with clinically suspected influenza, children with severe, complicated, or progressive illness attributable to influenza, and all children at high risk for complications, including children under 2 years of age and children with chronic medical conditions 1, 2.
The American Academy of Pediatrics also recommends that treatment may be considered for any otherwise healthy child with suspected influenza, especially if initiated within 48 hours of symptom onset, or for children whose household contacts are either younger than 6 months or have underlying medical conditions predisposing them to complications 1, 2.

The American Academy of Pediatrics recommends oseltamivir (oral suspension, 6 mg/mL concentration) as the preferred agent for all age groups, with weight-based dosing for children ≥12 months and age-based dosing for infants <12 months 1, 2.

The American Academy of Pediatrics recommends that treatment should not be delayed while awaiting laboratory confirmation—initiate therapy immediately based on clinical suspicion, local influenza activity, and patient risk factors, as the greatest clinical benefit occurs when treatment begins within 48 hours of symptom onset 1, 2.

Timely oseltamivir treatment provides measurable benefits, including reducing illness duration by approximately 1.5 days, decreasing risk of otitis media by 34-44%, reducing antibiotic prescriptions by approximately 10%, and lowering risk of complications including hospitalization and death, particularly in high-risk populations 3, 6.

Current surveillance data indicate that the vast majority of circulating influenza strains remain susceptible to oseltamivir, zanamivir, and peramivir, with <0.5% resistance rates for most strains 1, 2, 4.

The American Academy of Pediatrics recommends that treatment should not be withheld while awaiting laboratory confirmation in high-risk or severely ill children, and that negative rapid antigen tests should not be relied upon to rule out influenza or make treatment decisions 1, 2, 3.