Treatment Recommendations for Influenza

General Treatment Principles

The Centers for Disease Control and Prevention recommends antiviral treatment as soon as possible for all persons with suspected or confirmed influenza who are hospitalized, have severe, complicated, or progressive illness, or are at higher risk for influenza complications 3, 4
Early initiation of treatment (within 48 hours of symptom onset) provides the greatest benefit, but treatment should not be withheld if beyond this window, especially in severely ill patients 3, 1
Treatment should not be delayed while waiting for confirmatory test results in high-risk patients or those with severe illness 2, 5

Oseltamivir is a first-line treatment option for both influenza A and B, with a standard adult dose of 75 mg twice daily for 5 days 1, 5
Pediatric dosing for oseltamivir is weight-based, with doses ranging from 30 mg twice daily for patients ≤15 kg to 75 mg twice daily for patients >40 kg 5, 2
The most common side effect of oseltamivir is vomiting, which occurs in approximately 5% of patients 2

More clinical data are available concerning the efficacy of neuraminidase inhibitors for treatment of influenza A than for influenza B 3, 6
Observational studies suggest oseltamivir might be less effective for influenza B than influenza A, with Japanese children with influenza A resolving fever and stopping viral shedding more quickly than children with influenza B when treated with oseltamivir 3, 6, 7

For severely ill patients or immunocompromised patients, treatment is recommended regardless of time since symptom onset 1, 5
For hospitalized patients, oseltamivir treatment initiated within 2 days of symptom onset is associated with earlier hospital discharge 3, 4
Treatment may reduce the risk of complications such as pneumonia, respiratory failure, and death when initiated early 3, 4

The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend that antiviral medications are not a substitute for vaccination, which remains the cornerstone for influenza prevention 8
Consider empiric treatment during influenza season for patients presenting with typical symptoms, especially during community outbreaks 1