Influenza medical therapy: Difference between revisions

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==Medical Therapy==
==Medical Therapy==
===Antiviral Medications===
===Antiviral Medications===
{| style="border: 0px; font-size: 75%; margin: 3px; width:400px;" align=right
{| style="border: 0px; font-size: 75%; margin: 3px; width:400px;" align="right"
! style="background: #4479BA; color:#FFF;" |Persons at higher risk for influenza complications recommended for antiviral treatment include:
! style="background: #4479BA; color:#FFF;" |Persons at higher risk for influenza complications recommended for antiviral treatment include:
|-
|-
|style="background: #F5F5F5;"|
| style="background: #F5F5F5;" |
* Children aged younger than 2 years
* Children aged younger than 2 years
|-
|-
|style="background: #DCDCDC;"|
| style="background: #DCDCDC;" |
* Adults aged 65 years and older
* Adults aged 65 years and older
|-
|-
|style="background: #F5F5F5;"|
| style="background: #F5F5F5;" |
* Persons with the following comorbidities:
* Persons with the following comorbidities:
:*Chronic pulmonary (including asthma)
:*Chronic pulmonary (including asthma)
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:*Neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy, stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury)
:*Neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy, stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury)
|-
|-
|style="background: #DCDCDC;"|
| style="background: #DCDCDC;" |
* Persons with immunosuppression, including that caused by medications or by HIV infection
* Persons with immunosuppression, including that caused by medications or by HIV infection
|-
|-
|style="background: #F5F5F5;"|
| style="background: #F5F5F5;" |
* Women who are pregnant or postpartum (within 2 weeks after delivery)
* Women who are pregnant or postpartum (within 2 weeks after delivery)
|-
|-
|style="background: #DCDCDC;"|
| style="background: #DCDCDC;" |
* Persons aged younger than 19 years who are receiving long-term aspirin therapy
* Persons aged younger than 19 years who are receiving long-term aspirin therapy
|-
|-
|style="background: #F5F5F5;"|
| style="background: #F5F5F5;" |
* American Indians/Alaska Natives
* American Indians/Alaska Natives
|-
|-
|style="background: #DCDCDC "|
| style="background: #DCDCDC " |
* Persons who are morbidly obese (BMI > 40)
* Persons who are morbidly obese (BMI > 40)
|-
|-
|style="background: #F5F5F5; "|
| style="background: #F5F5F5; " |
* Residents of nursing homes and other chronic-care facilities.
* Residents of nursing homes and other chronic-care facilities.
|-
|-
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*Influenza antiviral prescription drugs can be used to treat influenza or to prevent influenza.
*Influenza antiviral prescription drugs can be used to treat influenza or to prevent influenza.
* Four licensed prescription influenza antiviral agents are available in the United States.
* Four licensed prescription influenza antiviral agents are available in the United States.
* Two FDA-approved influenza antiviral medications are recommended for use in the United States during the 2013-2014 influenza season:  
Neuraminidase inhibitors
*Two FDA-approved influenza antiviral medications are recommended for use in the United States during the 2013-2014 influenza season:
:*Oral [[oseltamivir]] (Tamiflu®)
:*Oral [[oseltamivir]] (Tamiflu®)
:*Inhaled [[zanamivir]] (Relenza®)
:*Inhaled [[zanamivir]] (Relenza®)
*[[Oseltamivir]] and [[zanamivir]] are chemically related antiviral medications known as neuraminidase inhibitors that have activity against both influenza A and B viruses.
*[[Oseltamivir]] and [[zanamivir]] are chemically related antiviral medications known as neuraminidase inhibitors that have activity against both influenza A and B viruses.
 Adamantanes
*[[Amantadine]] and [[rimantadine]] are antiviral drugs in a class of medications known as adamantanes.  
*[[Amantadine]] and [[rimantadine]] are antiviral drugs in a class of medications known as adamantanes.  
*Adamantanes are active against influenza A viruses, but not influenza B viruses.  
*Adamantanes are active against influenza A viruses, but not influenza B viruses.  
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[[Meta-analysis|Meta-analyses]] of [[randomized controlled trial]]s conflict with reviews by the [[Cochrane Collaboration]]<ref name="pmid24718923">{{cite journal| author= T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ et al.| title= inhibitors for preventing and treating influenza in healthy adults and children. | journal=Cochrane Database Syst Rev | year= 2014 | volume=  | issue= 4 | pages= CD008965 | pmid=24718923 | doi=10.1002/14651858.CD008965.pub4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24718923  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24985901 Review in: Evid Based Med. 2014 Dec;19(6):211]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25329219 Review in: Ann Intern Med. 2014 Oct 21;161(8):JC2] </ref> suggesting less benefit than reviews by industry<ref name="pmid25640810">{{cite journal| author=Dobson J, Whitley RJ, Pocock S, Monto AS| title=Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. | journal=Lancet | year= 2015 | volume= 385 | issue= 9979 | pages= 1729-37 | pmid=25640810 | doi=10.1016/S0140-6736(14)62449-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25640810  }} </ref>:
[[Meta-analysis|Meta-analyses]] of [[randomized controlled trial]]s conflict with reviews by the [[Cochrane Collaboration]]<ref name="pmid24718923">{{cite journal| author= T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ et al.| title= inhibitors for preventing and treating influenza in healthy adults and children. | journal=Cochrane Database Syst Rev | year= 2014 | volume=  | issue= 4 | pages= CD008965 | pmid=24718923 | doi=10.1002/14651858.CD008965.pub4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24718923  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24985901 Review in: Evid Based Med. 2014 Dec;19(6):211]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25329219 Review in: Ann Intern Med. 2014 Oct 21;161(8):JC2] </ref> suggesting less benefit than reviews by industry<ref name="pmid25640810">{{cite journal| author=Dobson J, Whitley RJ, Pocock S, Monto AS| title=Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. | journal=Lancet | year= 2015 | volume= 385 | issue= 9979 | pages= 1729-37 | pmid=25640810 | doi=10.1016/S0140-6736(14)62449-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25640810  }} </ref>:
* 25 hours<ref name="pmid25640810"/>
* 25 hours<ref name="pmid25640810" />
* 14 hours<ref name="pmid24718923"/>
* 14 hours<ref name="pmid24718923" />


====Drug Resistance====
====Drug Resistance====
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====Antiviral Medications Recommended for Treatment and Chemoprophylaxis of Influenza====
====Antiviral Medications Recommended for Treatment and Chemoprophylaxis of Influenza====


{| style="border: 0px; font-size: 90%; margin: 3px; width:900px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px; width:900px;" align="center"
|valign=top|
| valign="top" |
|+
|+
! style="background: #4479BA; color:#FFF;  width: 100px;" | Antiviral Agent
! style="background: #4479BA; color:#FFF;  width: 100px;" | Antiviral Agent
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! style="background: #4479BA; color:#FFF;  width: 200px;" | Adverse Reactions
! style="background: #4479BA; color:#FFF;  width: 200px;" | Adverse Reactions
|-  
|-  
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" rowspan=2 | Oseltamivir (Tamiflu®)  
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Oseltamivir (Tamiflu®)  
| style="padding: 5px 5px; background: #F5F5F5;" rowspan=2| Influenza A and B
| rowspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Influenza A and B
| style="padding: 5px 5px; background: #F5F5F5;" |Treatment
| style="padding: 5px 5px; background: #F5F5F5;" |Treatment
| style="padding: 5px 5px; background: #F5F5F5;" |Any age
| style="padding: 5px 5px; background: #F5F5F5;" |Any age
| style="padding: 5px 5px; background: #F5F5F5;" | N/A
| style="padding: 5px 5px; background: #F5F5F5;" | N/A
| style="padding: 5px 5px; background: #F5F5F5;" rowspan=2| Nausea, vomiting. Sporadic, transient neuropsychiatric events (self injury or delirium) mainly reported among Japanese adolescents and adults.
| rowspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Nausea, vomiting. Sporadic, transient neuropsychiatric events (self injury or delirium) mainly reported among Japanese adolescents and adults.
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Prophylaxis
| style="padding: 5px 5px; background: #F5F5F5;" |Prophylaxis
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| style="padding: 5px 5px; background: #F5F5F5;" | N/A
| style="padding: 5px 5px; background: #F5F5F5;" | N/A
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" rowspan=2 | Zanamivir (Relenza®)  
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Zanamivir (Relenza®)  
| style="padding: 5px 5px; background: #F5F5F5;" rowspan=2 | Influenza A and B
| rowspan="2" style="padding: 5px 5px; background: #F5F5F5;" | Influenza A and B
| style="padding: 5px 5px; background: #F5F5F5;" |Treatment
| style="padding: 5px 5px; background: #F5F5F5;" |Treatment
| style="padding: 5px 5px; background: #F5F5F5;" | > 7 years old
| style="padding: 5px 5px; background: #F5F5F5;" | > 7 years old
| style="padding: 5px 5px; background: #F5F5F5;" | Patients with underlying respiratory disease, such as asthma or COPD
| style="padding: 5px 5px; background: #F5F5F5;" | Patients with underlying respiratory disease, such as asthma or COPD
| style="padding: 5px 5px; background: #F5F5F5;" rowspan=2|Allergic reactions such as oropharyngeal or facial edema. Diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose and throat infections.
| rowspan="2" style="padding: 5px 5px; background: #F5F5F5;" |Allergic reactions such as oropharyngeal or facial edema. Diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose and throat infections.
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" |Prophylaxis
| style="padding: 5px 5px; background: #F5F5F5;" |Prophylaxis
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| style="padding: 5px 5px; background: #F5F5F5;" | Patients with underlying respiratory disease, such as asthma or COPD
| style="padding: 5px 5px; background: #F5F5F5;" | Patients with underlying respiratory disease, such as asthma or COPD
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" colspan=6|<small>Table adapted from CDC <ref name="CDC Antivirals"> {{cite web| url=http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm| title=CDC Influenza Antiviral Medications: Summary for Clinicians}}</ref></small>
| colspan="6" style="padding: 5px 5px; background: #F5F5F5;" |<small>Table adapted from CDC <ref name="CDC Antivirals">{{cite web| url=http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm| title=CDC Influenza Antiviral Medications: Summary for Clinicians}}</ref></small>
|}
|}


====Recommended Dosage and Duration of Influenza Antiviral Medications for Treatment or Chemoprophylaxis====
====Recommended Dosage and Duration of Influenza Antiviral Medications for Treatment or Chemoprophylaxis====
{| style="border: 0px; font-size: 90%; margin: 3px; width:900px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px; width:900px;" align="center"
|valign=top|
| valign="top" |
|+
|+
! style="background: #4479BA; color:#FFF;  width: 100px;" | Antiviral Agent
! style="background: #4479BA; color:#FFF;  width: 100px;" | Antiviral Agent
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! style="background: #4479BA; color:#FFF;  width: 200px;" | Prophylaxis (7 days)
! style="background: #4479BA; color:#FFF;  width: 200px;" | Prophylaxis (7 days)
|-  
|-  
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" rowspan=2 | Oseltamivir <br>(Tamiflu®)  
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Oseltamivir <br>(Tamiflu®)  
| style="padding: 5px 5px; background: #F5F5F5;" |Children
| style="padding: 5px 5px; background: #F5F5F5;" |Children
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
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*75 mg '''once''' a day
*75 mg '''once''' a day
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" rowspan=2 | Zanamivir <br> (Relenza®)
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Zanamivir <br> (Relenza®)
| style="padding: 5px 5px; background: #F5F5F5;" |Children
| style="padding: 5px 5px; background: #F5F5F5;" |Children
| style="padding: 5px 5px; background: #F5F5F5;" |For children > 7 yrs old.
| style="padding: 5px 5px; background: #F5F5F5;" |For children > 7 yrs old.
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* 10 mg (two 5-mg inhalations) '''once''' daily
* 10 mg (two 5-mg inhalations) '''once''' daily
|-  
|-  
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" rowspan=2 |  Peramivir (Rapivab®)
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Peramivir (Rapivab®)
| style="padding: 5px 5px; background: #F5F5F5;" | Children
| style="padding: 5px 5px; background: #F5F5F5;" | Children
| style="padding: 5px 5px; background: #F5F5F5;" | N/A
| style="padding: 5px 5px; background: #F5F5F5;" | N/A
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| style="padding: 5px 5px; background: #F5F5F5;" | N/A
| style="padding: 5px 5px; background: #F5F5F5;" | N/A
|-  
|-  
| style="padding: 5px 5px; background: #F5F5F5;" colspan=6|<small>Table adapted from CDC (as of 2015) <ref name="CDC Antivirals"> {{cite web| url=http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm| title=CDC Influenza Antiviral Medications: Summary for Clinicians}}</ref></small>
| colspan="6" style="padding: 5px 5px; background: #F5F5F5;" |<small>Table adapted from CDC (as of 2015) <ref name="CDC Antivirals">{{cite web| url=http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm| title=CDC Influenza Antiviral Medications: Summary for Clinicians}}</ref></small>
|}
|}


====Recommended Oseltamivir and Peramivir Dose Adjustments for Treatment or Chemoprophylaxis of Influenza in Adult Patients with Renal Impairment or End Stage Renal Disease (ESRD) on Dialysis====
====Recommended Oseltamivir and Peramivir Dose Adjustments for Treatment or Chemoprophylaxis of Influenza in Adult Patients with Renal Impairment or End Stage Renal Disease (ESRD) on Dialysis====


{| style="border: 0px; font-size: 90%; margin: 3px; width:900px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px; width:900px;" align="center"
|valign=top|
| valign="top" |
|+
|+
! style="padding: 5px 5px; background: #4479BA; color:#FFF; white-space: nowrap" | Antiviral Agent
! style="padding: 5px 5px; background: #4479BA; color:#FFF; white-space: nowrap" | Antiviral Agent
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! style="padding: 5px 5px; background: #4479BA; color:#FFF; white-space: nowrap" | Recommended Chemoprophylaxis Regimen
! style="padding: 5px 5px; background: #4479BA; color:#FFF; white-space: nowrap" | Recommended Chemoprophylaxis Regimen
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" rowspan=5 | Oral Oseltamivir  
| rowspan="5" style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Oral Oseltamivir  
| style="padding: 5px 5px; background: #F5F5F5;" | Creatinine clearance 61 to 90 mL/min
| style="padding: 5px 5px; background: #F5F5F5;" | Creatinine clearance 61 to 90 mL/min
| style="padding: 5px 5px; background: #F5F5F5;" | 75 mg '''twice''' a day
| style="padding: 5px 5px; background: #F5F5F5;" | 75 mg '''twice''' a day
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" rowspan=4 | Intravenous Peramivir (single dose)  
| rowspan="4" style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Intravenous Peramivir (single dose)  
| style="padding: 5px 5px; background: #F5F5F5;" | Creatinine clearance > 50 mL/min
| style="padding: 5px 5px; background: #F5F5F5;" | Creatinine clearance > 50 mL/min
| style="padding: 5px 5px; background: #F5F5F5;" | 600 mg
| style="padding: 5px 5px; background: #F5F5F5;" | 600 mg
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{| class="BlueTable" style="width:450px;  font-size:95%"
{| class="BlueTable" style="width:450px;  font-size:95%"
|+  
|+  
! style="width: 250px"|Symptom(s)
! style="width: 250px" |Symptom(s)
! style="width: 150px" |OTC Medicine
! style="width: 150px" |OTC Medicine
|-
|-

Revision as of 20:53, 20 October 2017

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For more information about non-human (variant) influenza viruses that may be transmitted to humans, see Zoonotic influenza

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

Antiviral therapy is recommended for patients who are at higher risk of complications from the Influenza virus. Antiviral drugs diminish symptoms, shorten the time of the disease, and prevent serious complications. The two main antiviral agents used in the treatment and prevention of influenza are Oseltamivir and Zanamivir. For the majority of patients, the treatment of influenza is primarily symptomatic and includes Analgesics, Antihistamines, Decongestants and cough suppressants.

Medical Therapy

Antiviral Medications

Persons at higher risk for influenza complications recommended for antiviral treatment include:
  • Children aged younger than 2 years
  • Adults aged 65 years and older
  • Persons with the following comorbidities:
  • Chronic pulmonary (including asthma)
  • Cardiovascular (except hypertension alone)
  • Renal, hepatic, hematological (including sickle cell disease) or metabolic disorders (including diabetes mellitus)
  • Neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy, stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury)
  • Persons with immunosuppression, including that caused by medications or by HIV infection
  • Women who are pregnant or postpartum (within 2 weeks after delivery)
  • Persons aged younger than 19 years who are receiving long-term aspirin therapy
  • American Indians/Alaska Natives
  • Persons who are morbidly obese (BMI > 40)
  • Residents of nursing homes and other chronic-care facilities.
  • Antiviral medications with activity against influenza viruses are an important adjunct to influenza vaccine in the control of influenza.
  • Influenza antiviral prescription drugs can be used to treat influenza or to prevent influenza.
  • Four licensed prescription influenza antiviral agents are available in the United States.

Neuraminidase inhibitors

  • Two FDA-approved influenza antiviral medications are recommended for use in the United States during the 2013-2014 influenza season:
  • Oseltamivir and zanamivir are chemically related antiviral medications known as neuraminidase inhibitors that have activity against both influenza A and B viruses.

 Adamantanes

  • Amantadine and rimantadine are antiviral drugs in a class of medications known as adamantanes.
  • Adamantanes are active against influenza A viruses, but not influenza B viruses.

Antiviral Therapy Recommendations

Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who has any of the follwing conditions:

  • Is hospitalized.
  • Has severe, complicated, or progressive illness.
  • Is at higher risk for influenza complications (detailed in the table on the right).


Meta-analyses of randomized controlled trials conflict with reviews by the Cochrane Collaboration[1] suggesting less benefit than reviews by industry[2]:

Drug Resistance

  • Antiviral resistance to oseltamivir and zanamivir among circulating influenza viruses is currently low, but this might change.
  • Also, antiviral resistance can emerge during or after treatment in certain patients, such as immunosuppressed individuals.
  • As in recent past seasons, there is a high prevalence (>99%) of influenza A(H3N2) and influenza A(H1N1) (2009 H1N1) viruses resistant to adamantanes.
  • Therefore, amantadine and rimantadine are not recommended for antiviral treatment or chemoprophylaxis of currently circulating influenza A viruses.

Antiviral Medications Recommended for Treatment and Chemoprophylaxis of Influenza

Antiviral Agent Activity Against Use Recommended For Not Recommended for Use in Adverse Reactions
Oseltamivir (Tamiflu®) Influenza A and B Treatment Any age N/A Nausea, vomiting. Sporadic, transient neuropsychiatric events (self injury or delirium) mainly reported among Japanese adolescents and adults.
Prophylaxis > 3 months of age N/A
Zanamivir (Relenza®) Influenza A and B Treatment > 7 years old Patients with underlying respiratory disease, such as asthma or COPD Allergic reactions such as oropharyngeal or facial edema. Diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose and throat infections.
Prophylaxis > 5 years old Patients with underlying respiratory disease, such as asthma or COPD
Table adapted from CDC [3]

Recommended Dosage and Duration of Influenza Antiviral Medications for Treatment or Chemoprophylaxis

Antiviral Agent Patient Treatment (5 days) Prophylaxis (7 days)
Oseltamivir
(Tamiflu®)
Children
  • < 1 yr: 3 mg/kg/dose twice daily
  • > 1 yr: dose depends on weight.
  • ≤ 15 kg: 30 mg twice a day
  • > 15 to 23 kg: 45 mg twice a day
  • > 23 to 40 kg: 60 mg twice a day
  • > 40 kg: 75 mg twice a day
  • Not recommended for children < 3 months old.
  • 3 months to 1 yr: 3 mg/kg/dose once daily
  • > 1 yr: dose depends on weight.
  • ≤ 15 kg: 30 mg once a day
  • > 15 to 23 kg: 45 mg once a day
  • > 23 to 40 kg: 60 mg once a day
  • > 40 kg: 75 mg once a day
Adults
  • 75 mg twice a day
  • 75 mg once a day
Zanamivir
(Relenza®)
Children For children > 7 yrs old.
  • 10 mg (two 5-mg inhalations) twice daily
For children > 7 yrs old.
  • 10 mg (two 5-mg inhalations) once daily
Adults
  • 10 mg (two 5-mg inhalations) twice daily
  • 10 mg (two 5-mg inhalations) once daily
Peramivir (Rapivab®) Children N/A N/A
Adults 600 mg IV for 15-30 minutes (single dose) N/A
Table adapted from CDC (as of 2015) [3]

Recommended Oseltamivir and Peramivir Dose Adjustments for Treatment or Chemoprophylaxis of Influenza in Adult Patients with Renal Impairment or End Stage Renal Disease (ESRD) on Dialysis

Antiviral Agent Creatinine Clearance Recommended Treatment Regimen Recommended Chemoprophylaxis Regimen
Oral Oseltamivir Creatinine clearance 61 to 90 mL/min 75 mg twice a day 75 mg once daily
Creatinine clearance 31 to 60 mL/min 30 mg twice a day 30 mg once daily
Creatinine clearance 10 to 30 mL/min 30 mg once daily 30 mg every other day
ESRD Patients on Hemodialysis (Creatinine clearance ≤10 mL/min) 30 mg after every hemodialysis cycle. Treatment duration not to exceed 5 days 30 mg after alternate hemodialysis cycles
ESRD Patients on Continuous Ambulatory Peritoneal Dialysis (Creatinine clearance ≤10 mL/min) A single 30 mg dose administered immediately after a dialysis exchange 30 mg once weekly immediately after dialysis exchange
Intravenous Peramivir (single dose) Creatinine clearance > 50 mL/min 600 mg N/A
Creatinine clearance 30-49 mL/min 200 mg N/A
Creatinine clearance 10-29 mL/min 100 mg N/A
ESRD Patients on Hemodialysis Dose administered after dialysis at a dose adjusted based on creatinine clearance

Symptomatic Therapy

Over the counter (OTC) medicines may be taken to relieve influenza symptoms, but they do not affect the virus. [4]

Symptom(s) OTC Medicine
Fever, Aches, Pains, Sinus pressure, Sore throat Analgesics
Nasal congestion, Sinus pressure Decongestants
Sinus pressure, Runny nose, Watery eyes, Cough Antihistamines
Cough Cough suppressant
Sore throat Local anesthetics
  • Children and teenagers with flu symptoms (particularly fever) should avoid taking aspirin as taking aspirin in the presence of influenza infection (especially Influenzavirus B) can lead to Reye's syndrome, a rare but potentially fatal disease of the liver.[5]

References

  1. 1.0 1.1 T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ; et al. (2014). "inhibitors for preventing and treating influenza in healthy adults and children". Cochrane Database Syst Rev (4): CD008965. doi:10.1002/14651858.CD008965.pub4. PMID 24718923. Review in: Evid Based Med. 2014 Dec;19(6):211 Review in: Ann Intern Med. 2014 Oct 21;161(8):JC2
  2. 2.0 2.1 Dobson J, Whitley RJ, Pocock S, Monto AS (2015). "Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials". Lancet. 385 (9979): 1729–37. doi:10.1016/S0140-6736(14)62449-1. PMID 25640810.
  3. 3.0 3.1 "CDC Influenza Antiviral Medications: Summary for Clinicians".
  4. "Cold and Flu Guidelines: Influenza". American Lung Association. Retrieved 2007-09-16.
  5. Molotsky, Irvin (1986-02-15). "Consumer Saturday - Warning on Flu and Aspirin". New York Times. Retrieved 2007-05-25.

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