What are the indications for Tamiflu (oseltamivir)?

Indications for Tamiflu (Oseltamivir)

Tamiflu (oseltamivir) is indicated for the treatment of acute, uncomplicated influenza A and B in patients 2 weeks of age and older who have been symptomatic for no more than 48 hours, and for prophylaxis of influenza A and B in patients 1 year and older. 1

Treatment Indications

• Oseltamivir is the antiviral drug of choice for the management of illness caused by influenza virus infections and is the only drug recommended by the American Academy of Pediatrics (AAP) for treatment of hospitalized children 2

• Treatment of acute, uncomplicated influenza A and B in patients 2 weeks of age and older who have been symptomatic for no more than 48 hours 1

• Treatment should be prioritized for:

  • Hospitalized patients with presumed influenza 2
  • Patients with severe, complicated, or progressive illness attributable to influenza 2
  • Patients at high risk of influenza complications, regardless of duration of symptoms 2

• Children younger than 2 years are at increased risk of hospitalization and complications from influenza, making them a priority group for treatment 2

Prophylaxis Indications

• Prevention of influenza A and B in patients 1 year and older 1

• Prophylaxis can be used in two contexts:

  • Post-exposure prophylaxis for household contacts of infected persons when administered within 48 hours of symptom onset in the infected person 3
  • Seasonal prophylaxis during periods of local influenza activity 3

Special Populations

• Oseltamivir can be used to treat influenza in both term and preterm infants from birth, as the benefits of therapy are likely to outweigh possible risks of treatment 2

• The FDA has licensed oseltamivir for children as young as 2 weeks of age 2

• Specific dosing recommendations are available for preterm infants based on postmenstrual age 2

Limitations of Use

• Oseltamivir is not a substitute for annual influenza vaccination 1

• Treatment should be started as soon as possible after illness onset and should not be delayed while waiting for a definitive influenza test result 2

• Treatment after 48 hours of symptoms in adults and children with moderate to severe disease or with progressive disease has been shown to provide some benefit and should be offered 2

• Not recommended for patients with end-stage renal disease not undergoing dialysis 1

Clinical Benefits

• When administered within 2 days of illness onset, oseltamivir can reduce the duration of uncomplicated influenza illness by approximately 1 day compared with placebo 2, 3

• Treatment can reduce the severity of illness by up to 38% when initiated within 36 hours of symptom onset 3

• Earlier treatment provides better clinical outcomes 2

• Reduces the incidence of secondary complications and the use of antibacterials 3

Important Considerations

• The emergence of resistance substitutions could decrease drug effectiveness 1

• Oseltamivir is preferred over other antivirals because of the cumulative experience with this drug in children, relative cost, and ease of administration 2

• Although inhaled zanamivir is an acceptable alternative for patients 7 years and older who do not have chronic respiratory disease, oseltamivir is favored in children 5-17 years of age 2

• The most common adverse events with oseltamivir treatment are nausea and vomiting, which can be mitigated by taking the medication with food 2, 3