Should an 8-year-old child who recently completed a course of amoxicillin (amoxicillin) for strep throat and has now been diagnosed with influenza A be treated with oseltamivir (oseltamivir)?

Treatment of Influenza A in an 8-Year-Old Child

Yes, treat this 8-year-old child with oseltamivir for influenza A, regardless of the recent amoxicillin course for strep throat. 1

Primary Recommendation

The American Academy of Pediatrics recommends antiviral treatment for any otherwise healthy child with suspected influenza, especially when treatment can be initiated within 48 hours of illness onset. 1 While children under 2 years are at highest risk and require mandatory treatment, treatment should be considered for all children to reduce symptom duration and complication risk. 1

Key Benefits of Treatment

• Oseltamivir reduces illness duration by approximately 36 hours (26% reduction) when started within 48 hours of symptom onset. 1
• The risk of otitis media is reduced by 34% in treated children. 1
• Treatment decreases the risk of hospitalization and other complications. 1

Dosing for an 8-Year-Old

For an 8-year-old child, dosing depends on weight: 1

• If weight >23-40 kg: 60 mg twice daily for 5 days
• If weight >40 kg: 75 mg twice daily for 5 days

Treatment should be given for a full 5-day course. 1

Timing Considerations

• Do not delay treatment while waiting for confirmatory influenza testing—clinical judgment based on symptoms and local influenza activity is sufficient. 1
• Greatest benefit occurs within 48 hours of symptom onset, but treatment can still be beneficial even if started later. 1

Safety Profile

• Vomiting is the most common side effect, occurring in approximately 5-15% of treated patients, but is generally mild and transient. 1, 2
• Despite historical concerns, controlled clinical trials and ongoing surveillance have failed to establish a link between oseltamivir and neurologic or psychiatric events. 1

Important Clinical Considerations

• The recent amoxicillin course for strep throat is irrelevant to the influenza A treatment decision—these are separate infections requiring different treatments. 1
• Oseltamivir has no interaction concerns with recently completed amoxicillin therapy. 1
• The child does not fall into the mandatory high-risk category (age <2 years), but treatment is still recommended to reduce symptom burden and prevent complications. 1

Common Pitfalls to Avoid

• Do not withhold treatment because the child is "otherwise healthy"—even healthy children benefit from reduced illness duration and complication risk. 1
• Do not rely on rapid antigen tests to rule out influenza, as these have low sensitivity and negative results should not guide treatment decisions. 1
• Do not delay treatment beyond 48 hours if possible, as efficacy decreases with later initiation. 1