Influenza Treatment Guidelines

Patient Selection and Dosing

The American Academy of Pediatrics recommends oseltamivir dosing for children ≥12 months based on weight:
Body Weight Treatment (5 days)
≤15 kg (≤33 lb) 30 mg twice daily
>15-23 kg (33-51 lb) 45 mg twice daily
>23-40 kg (51-88 lb) 60 mg twice daily
>40 kg (>88 lb) 75 mg twice daily
1, 2, 3, 4
For infants 9-11 months, the recommended dose is 3.5 mg/kg twice daily for treatment and 3.5 mg/kg once daily for prophylaxis, as per the Centers for Disease Control and Prevention guidelines 4
For term infants 0-8 months, the recommended dose is 3 mg/kg twice daily for treatment and 3 mg/kg once daily for prophylaxis, according to the American Academy of Pediatrics 1, 2, 3, 5
For preterm infants, dosing is based on postmenstrual age:
Postmenstrual Age Treatment (5 days)
<38 weeks 1.0 mg/kg twice daily
38-40 weeks 1.5 mg/kg twice daily
>40 weeks 3.0 mg/kg twice daily
1, 4
For adults, oseltamivir should be dosed at 75 mg twice daily for 5 days for treatment, according to the American Academy of Pediatrics, with weight-based dosing recommended for children 2, 3, 4

For patients with renal impairment (creatinine clearance 10-30 mL/min), the treatment dose is 75 mg once daily for 5 days, and the prophylaxis dose is 30 mg once daily or 75 mg once every other day for 10 days, as recommended by the American Academy of Pediatrics 2, 3, 4
For extremely preterm infants (<28 weeks), consultation with a pediatric infectious disease specialist is recommended, as advised by the American Academy of Pediatrics 4, 6

Treatment should be initiated as soon as possible, ideally within 48 hours of symptom onset for maximum effectiveness 1
Patients should be monitored for persistent or worsening fever beyond 48-72 hours after starting treatment, and for development of complications such as secondary bacterial infections, pneumonia, otitis media, and sinusitis 3
Treatment should be considered for any child hospitalized with presumed influenza, regardless of duration of symptoms 2
The standard treatment duration is 5 days for all age groups, as recommended by the American Academy of Pediatrics 2, 3, 4, 7
The prophylaxis duration is 10 days after exposure, according to the American Academy of Pediatrics 2, 3, 4

Oseltamivir can be administered without regard to meals, but taking with food may improve gastrointestinal tolerability, according to the American Academy of Pediatrics 2, 3
Oseltamivir is available as capsules (30 mg, 45 mg, 75 mg) and oral suspension (6 mg/mL), as stated by the American Academy of Pediatrics 3, 4
If commercial suspension is unavailable, capsules may be opened and mixed with sweetened liquid, as advised by the American Academy of Pediatrics 2, 3