From the Guidelines
Antiviral medications for children should be prescribed based on the specific viral infection being treated, the child's age, weight, and medical history, with oseltamivir (Tamiflu) being commonly prescribed for influenza at 30-75 mg twice daily for 5 days, with dosing adjusted by weight (3-5 mg/kg/dose) 1.
Key Considerations
- The child's age, weight, and medical history should be taken into account when prescribing antiviral medications.
- Oseltamivir (Tamiflu) is commonly prescribed for influenza, with dosing adjusted by weight (3-5 mg/kg/dose).
- Treatment should be started as soon as possible after illness onset, ideally within 48 hours of symptom onset for influenza.
- Side effects vary by medication but can include nausea, vomiting, and headache.
Antiviral Medications for Children
- Oseltamivir (Tamiflu) is available in capsule and oral suspension formulations, with dosing recommendations as follows:
- Adults: 75 mg twice daily for 5 days
- Children ≥12 mo: 30-75 mg twice daily for 5 days, with dosing adjusted by weight (3-5 mg/kg/dose)
- Infants 9-11 mo: 3.5 mg/kg per dose twice daily for 5 days
- Term infants 0-8 mo: 3 mg/kg per dose twice daily for 5 days
- Zanamivir is administered by inhalation using a proprietary "Diskhaler" device, with dosing recommendations as follows:
- Adults: 10 mg (two 5-mg inhalations) twice daily for 5 days
- Children ≥7 y: 10 mg (two 5-mg inhalations) twice daily for 5 days
Important Notes
- Treatment should not be delayed while waiting for a definitive influenza test result, as early therapy provides the best outcomes.
- Clinical judgment is an important factor in treatment decisions for pediatric patients who present with influenza-like illness.
- The FDA has licensed oseltamivir for children as young as 2 weeks of age, with preliminary pharmacokinetic data and limited safety data supporting its use in this age group 1.
From the FDA Drug Label
Pediatric Subjects (1 year to 12 years of age) The pharmacokinetics of oseltamivir and oseltamivir carboxylate have been evaluated in a single-dose pharmacokinetic study in pediatric subjects aged 5 to 16 years (n=18) and in a small number of pediatric subjects aged 3 to 12 years (n=5) enrolled in a clinical trial Younger pediatric subjects cleared both the prodrug and the active metabolite faster than adult subjects resulting in a lower exposure for a given mg/kg dose. For oseltamivir carboxylate, apparent total clearance decreases linearly with increasing age (up to 12 years) The pharmacokinetics of oseltamivir in pediatric subjects over 12 years of age are similar to those in adult subjects [see Use in Specific Populations (8. 4)] . Pediatric Subjects (2 weeks to less than 1 year of age) The pharmacokinetics of oseltamivir and oseltamivir carboxylate have been evaluated in two open-label studies of pediatric subjects less than one year of age (n=122) infected with influenza Apparent clearance of the active metabolite decreases with decreasing age in subjects less than 1 year of age; however the oseltamivir and oseltamivir carboxylate exposure following a 3 mg/kg dose in subjects under 1 year of age is expected to be within the observed exposures in adults and adolescents receiving 75 mg twice daily and 150 mg twice daily [see Use in Specific Populations (8. 4)] .
Oseltamivir can be used in children.
- The pharmacokinetics of oseltamivir have been evaluated in pediatric subjects.
- Pediatric subjects under 1 year of age have decreased apparent clearance of the active metabolite.
- Dosing for pediatric subjects is not explicitly stated in the provided text, but it is mentioned that a 3 mg/kg dose in subjects under 1 year of age is expected to be within the observed exposures in adults and adolescents receiving 75 mg twice daily and 150 mg twice daily 2.
From the Research
Antiviral Medications for Children
- Antiviral drugs are available for the treatment of certain infectious agents in children, such as acyclovir for herpes simplex virus encephalitis 3.
- Recommendations for flu treatment in children may change according to current epidemiological surveillance data, with oseltamivir, zanamivir, peramivir, and baloxavir being recommended for the 2020-21 flu season 3.
- Antiretroviral prophylaxis in newborns from HIV-1 infected mothers must be initiated as soon as possible, with one or more drugs according to therapeutic regimens based on the baby's risk category 3.
Treatment of Specific Viral Infections
- Influenza virus can cause severe or life-threatening infection in children, and antiviral medications such as oseltamivir and zanamivir are available for treatment and prevention 4.
- Children with suspected or documented influenza infection benefit from early antiviral treatment with neuraminidase inhibitors, which can shorten illness duration, decrease symptom severity, and lower the risk of complications 4.
- Treatment with direct antiviral agents against hepatitis C virus is approved for children over the age of three, and consists of different therapeutic regimens chosen based on the viral genotype 3.
Availability of Antiviral Drugs for Children
- Several antiretroviral drugs are available for use in children, but only 38% of antiretroviral drugs approved for adults are approved for children under the age of two, and about 60% are approved for children under the age of twelve 3.
- Many viral infections in children result in self-limited illness and are treated symptomatically, but some can be successfully treated with antiviral medications, such as herpes simplex virus, influenza virus, and cytomegalovirus 5.
Clinically Relevant Antiviral Medications
- A brief overview of drug categories, mechanism of action, resistance, pharmacokinetics, and side effects is provided for commonly prescribed antivirals, including those for treatment and prophylaxis of influenza, neonatal herpes simplex virus, and congenital cytomegalovirus 6.
- Several new agents for treating viral infections have been developed in recent years, including acyclovir, ganciclovir, famciclovir, and valacyclovir, which are useful in the treatment of various viral infections 7.