Tamiflu (Oseltamivir) Indications
Tamiflu 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
Primary Treatment Populations
Offer treatment as soon as possible to:
- Children hospitalized with presumed or confirmed influenza 2
- Children with severe, complicated, or progressive illness attributable to influenza 2
- Children at high risk of complications from influenza (see high-risk conditions below) 2
Consider Treatment For:
- Any otherwise healthy child with presumed influenza, particularly if they can be treated within 48 hours of symptom onset 2
- Healthy children with presumed influenza who live with siblings or household contacts <6 months old or with medical conditions predisposing to complications 2
High-Risk Conditions Warranting Treatment
Children with any of the following conditions should receive treatment 2:
- Age <2 years (especially <6 months)
- Chronic pulmonary disease (including asthma)
- Cardiovascular disease (excluding hypertension alone)
- Immunosuppression
- Neurologic/neurodevelopmental conditions
- Metabolic disorders (including diabetes)
- Renal dysfunction
- Hemoglobinopathies
- Compromised respiratory function requiring mechanical ventilation, tracheostomy, or baseline oxygen
Prophylaxis Indications
Oseltamivir is indicated for prevention of influenza in patients ≥1 year of age 1:
- Post-exposure prophylaxis: 75 mg once daily for 10 days in adults/adolescents (weight-based dosing in children 1-12 years) 1
- Community outbreak prophylaxis: 75 mg once daily for up to 6 weeks in adults/adolescents (weight-based dosing in children 1-12 years) 1
Age-Specific Approvals
- Treatment: FDA-approved for patients ≥2 weeks of age 1
- Prophylaxis: FDA-approved for patients ≥1 year of age 1
- Off-label use in neonates: The AAP supports use in term and preterm infants from birth for treatment, as benefits outweigh risks, though this is not FDA-approved 2, 3
Critical Timing Considerations
Treatment is most effective when initiated within 48 hours of symptom onset 2, 1. However, treatment should still be considered after 48 hours in children with severe, complicated, or progressive disease, as some benefit has been demonstrated 2.
Do not delay treatment while awaiting laboratory confirmation of influenza 2. Clinical judgment based on local influenza activity and patient presentation should guide immediate treatment decisions 2.
Important Limitations
- Not a substitute for annual influenza vaccination 1
- Not recommended for patients with end-stage renal disease not undergoing dialysis 1
- Consider local influenza drug susceptibility patterns when deciding whether to use 1
- The efficacy in preventing serious influenza-related complications (bacterial pneumonia, exacerbation of chronic diseases) has not been definitively established 2
Clinical Benefits
When used appropriately, oseltamivir provides 3:
- Reduction in median duration of illness by 36 hours (26%) in children with laboratory-confirmed influenza
- Significant reduction in risk of acute otitis media in children 1-5 years of age
- Improved recovery and shorter hospital stays in children with influenza A