Influenza Guidelines

Influenza Guidelines

Treatment Recommendations

Oseltamivir x 5 days

Dosing is weight-based:

  • ≤15 kg: 30 mg by mouth twice daily
  • >15 to 23 kg: 45 mg by mouth twice daily
  • >23 to 40 kg: 60 mg by mouth twice daily
  • >40 kg: 75 mg by mouth twice daily

Oseltamivir Criteria for Use

Oseltamivir is Currently on National Shortage

In order to ensure supply is sufficient to treat our highest risk patients, oseltamivir will be prioritized using a risk-based tiering system. Oseltamivir use will open to additional tiers when supply allows

Currently Active Tier(s): 1 (No Restrictions)

Use of oseltamivir will be limited to 5-day courses. Use of extended courses (7-10 days) should be done only in consultation with Infectious Diseases.

Patients with symptomatic influenza meeting the following criteria:

TIER 1 (No Restrictions):

Status: ACTIVE

  • Patients hospitalized with influenza
  • Outpatients at high-risk of complications
  • Outpatients with severe or progressive illness

TIER 2 (Intermediate Risk):

Status: Available under Tier 1

  • Adults 65 years and older
  • Adults with at-risk comorbidities:
    • Neurologic and neurodevelopment conditions
    • Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
    • Diabetes mellitus
    • Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
    • Chronic Kidney Disease
    • Underlying hepatic Disease
    • Body mass index [BMI] of 40 or higher
  • Pediatric patients hospitalized with influenza regardless of risk factors

TIER 3 (Highest Risk):

Status: Available under Tier 1

  • Immunocompromised (whether by disease process or immunosuppressing medications)
  • Sickle Cell Disease
  • Pregnancy
  • Pediatric patients meeting at least one high-risk criteria (see American Academy of Pediatrics Influenza High-Risk Groups in Pediatrics available here and CDC High-Risk Criteria for Pediatrics available here).

Alternative Therapies

  1. Baloxovir
    • Baloxivir is non-formulary and is not approved nor recommended for use in hospitalized patients
    • Baloxivir is a potential alternative to oseltamivir for non-hospitalized patients
  2. Adamantanes (e.g. Amandatine) are not recommended due to high levels of resistance
  3. Other neuraminidase-inhibitors are also suffering from national shortage concerns