Oseltamivir Dosing for a 23 kg Child
For a 23 kg child, the recommended dose of oseltamivir is 60 mg twice daily for treatment (5 days) or 60 mg once daily for prophylaxis (10 days). 1, 2
Weight-Based Dosing Algorithm
A 23 kg child falls into the >23 to 40 kg weight category, which requires specific dosing:
Treatment Dosing (5 days):
- 60 mg twice daily (approximately every 12 hours) 1, 2
- This equals 10 mL of oral suspension (6 mg/mL concentration) per dose 1, 2
- Initiate within 48 hours of symptom onset for maximum effectiveness 2, 3
Prophylaxis Dosing (10 days):
- 60 mg once daily 1, 2
- This equals 10 mL of oral suspension per dose 1, 2
- Duration: 10 days for post-exposure prophylaxis or up to 6 weeks during community outbreak 2
Formulation Options
The child can receive oseltamivir as: 1, 2
- Oral suspension: 10 mL of 6 mg/mL suspension (60 mg dose)
- Capsule: One 60 mg capsule (if able to swallow capsules)
Administration Pearls
- Administer with food to improve gastrointestinal tolerability and reduce nausea/vomiting 1, 4, 5, 3
- Use an accurate oral dosing device that measures in mL for liquid formulation 2
- Nausea and vomiting are the most common adverse effects but are typically mild and transient 3
Critical Weight Thresholds to Remember
The dosing changes at specific weight cutoffs: 1, 2
- ≤15 kg: 30 mg per dose
- >15 to 23 kg: 45 mg per dose
- >23 to 40 kg: 60 mg per dose (applies to this 23 kg child)
- >40 kg: 75 mg per dose
Common Pitfall
Do not underdose at exactly 23 kg. The guidelines consistently state "more than 23 kg" or ">23 kg" receives 60 mg, while "15 to 23 kg" receives 45 mg. 1, 2 At exactly 23 kg, the child is at the upper boundary and pharmacokinetic data support using the higher dose (60 mg) to ensure adequate drug exposure, as children eliminate oseltamivir carboxylate faster than adults. 6, 7