Can children be prescribed Tamiflu (oseltamivir) for influenza?

Can Children Receive Tamiflu (Oseltamivir)?

Yes, children can absolutely receive Tamiflu (oseltamivir), and it is FDA-approved for use in children as young as 2 weeks of age for treatment of influenza. 1, 2

Age-Specific Approval and Dosing

Treatment Eligibility by Age

• Children 2 weeks to 17 years: Oseltamivir is approved and safe for treatment of influenza across this entire age range 1, 2
• Adolescents ≥13 years: Receive adult dosing of 75 mg twice daily for 5 days 1, 3
• Children 1-12 years: Require weight-based dosing ranging from 30-75 mg twice daily for 5 days 1, 4
• Infants 2 weeks to <1 year: Use age-based and weight-based dosing (3-3.5 mg/kg twice daily) 1, 3
• Preterm infants: Require special postmenstrual age-based dosing due to immature renal function 1, 3

Prophylaxis Eligibility

• Children ≥1 year: Approved for prophylaxis using the same weight-based doses as treatment, but once daily instead of twice daily for 10 days 4
• Infants 3-11 months: Can receive prophylaxis at 3 mg/kg once daily for 10 days 4
• Infants <3 months: Prophylaxis is not recommended unless the situation is judged critical due to limited safety data 3

Detailed Pediatric Dosing Algorithm

For Children ≥12 Months (Weight-Based)

• ≤15 kg (≤33 lb): 30 mg twice daily for 5 days 1, 4
• >15-23 kg (>33-51 lb): 45 mg twice daily for 5 days 1, 4
• >23-40 kg (>51-88 lb): 60 mg twice daily for 5 days 1, 4
• >40 kg (>88 lb): 75 mg twice daily for 5 days 1, 4

For Infants <12 Months (Age-Based)

• 9-11 months: 3.5 mg/kg per dose twice daily for 5 days 1, 3
• Term infants 0-8 months: 3 mg/kg per dose twice daily for 5 days 1, 3

For Preterm Infants (Postmenstrual Age-Based)

• <38 weeks postmenstrual age: 1.0 mg/kg twice daily 1, 3
• 38-40 weeks postmenstrual age: 1.5 mg/kg twice daily 1, 3
• >40 weeks postmenstrual age: 3.0 mg/kg twice daily 1, 3

Critical Clinical Considerations

Timing of Treatment

Treatment must be initiated within 48 hours of symptom onset for maximum effectiveness 1, 3. Earlier initiation is associated with faster symptom resolution and better outcomes 5, 6.

When to Treat Children

The American Academy of Pediatrics recommends treatment for: 5, 7

• Children at high risk of severe infection (age <2 years, chronic underlying diseases)
• Children with moderate-to-severe influenza infection
• Children with confirmed influenza by reliable laboratory testing to avoid unnecessary treatment 7

Formulation Options for Children

• Capsules: Available in 30 mg, 45 mg, and 75 mg strengths 1, 4
• Oral suspension: 6 mg/mL concentration when reconstituted 1, 4
• Capsule contents can be opened and mixed with liquid for children who cannot swallow capsules whole 1

Administration Tips to Improve Tolerability

• Give with food to reduce gastrointestinal side effects (nausea and vomiting occur in 5-15% of patients) 1, 3, 6
• Nausea and vomiting are the most common adverse effects but are typically mild and transient 1, 6

Special Populations

Renal Impairment

For children with creatinine clearance 10-30 mL/min: 1, 4

• Treatment: 75 mg once daily for 5 days (instead of twice daily)
• Prophylaxis: 30 mg once daily for 10 days OR 75 mg every other day for 10 days

Drug Interactions

Avoid live attenuated influenza vaccine (LAIV) within 48 hours before oseltamivir, and do not use oseltamivir for 14 days after LAIV vaccination 1, 4. This is because oseltamivir may interfere with vaccine effectiveness.

Common Pitfalls to Avoid

• Do not delay treatment waiting for laboratory confirmation if clinical suspicion is high and the child is at risk for complications 5, 7
• Do not use adult dosing for children - weight-based or age-based dosing is essential for safety and efficacy 1, 3
• Do not forget to adjust dosing for preterm infants based on postmenstrual age rather than chronological age to avoid toxicity 1, 3
• Do not prescribe for mild influenza in otherwise healthy children unless they are at high risk or have severe symptoms 7