Dosing recommendations for antiviral agents for the treatment of influenza in children and adolescents^[1-3]

Drug/formulation	Dosing recommendations
Oseltamivir (Tamiflu)*
30 mg capsule 45 mg capsule 75 mg capsule 6 mg/mL suspension^¶	1 through 12 years
	Children ≥12 months should receive approximately 4 mg/kg per day orally divided into 2 doses for a 5-day treatment course
	≤15 kg	>15 to 23 kg	>23 to 40 kg	>40 kg
	60 mg/day orally divided into 2 doses for 5 days	90 mg/day orally divided into 2 doses for 5 days	120 mg/day orally divided into 2 doses for 5 days	150 mg/day orally divided into 2 doses for 5 days
	≥13 years
	150 mg/day orally divided into 2 doses for 5 days
Baloxavir (Xofluza)^Δ
40 mg tablet 80 mg tablet 2 mg/mL oral suspension	≥5 years
	Weight <20 kg (oral suspension) – 2 mg/kg orally as a single dose Weight 20 to <80 kg (oral suspension or tablet) – 40 mg orally as a single dose Weight ≥80 kg (oral suspension or tablet) – 80 mg orally as a single dose
Peramivir (Rapivab)*
200 mg in 20 mL (10 mg/mL) in a single-use vial	6 months through 12 years
	12 mg/kg per dose IV as a single dose (maximum dose 600 mg)
	≥13 years
	600 mg IV as a single dose
Zanamivir (Relenza)^◊
5 mg per inhalation (Diskhaler)	≥7 years
	2 inhalations (10 mg total per dose) twice daily for 5 days^§

This table is meant for use with UpToDate content related to treatment of seasonal influenza in children. The choice of agent for treatment may vary with the age of the child and susceptibility patterns of circulating strains. Refer to UpToDate content for additional details, including indications for treatment and dosing recommendations for oseltamivir in infants younger than 1 year.

IV: intravenously.

* Dose adjustment is necessary for patients with renal insufficiency.

¶ When dispensing the oral suspension of oseltamivir, providers and pharmacists must take care to provide a dosing device that matches the units of measure on the prescription.

Δ Baloxavir is available in Japan for the treatment of influenza in children <12 years of age who weigh at least 10 kg. Refer to Japanese prescribing information for dosing information for children <12 years of age.

◊ Zanamivir is not recommended for the treatment of hospitalized patients, because of limited data in patients with severe influenza. Zanamivir inhalation powder should not be reconstituted in any liquid formulation and is not recommended for use in nebulizers or mechanical ventilators.

§ Two doses should be administered on day 1, provided that the doses can be spaced at least 2 hours apart.

References:

American Academy of Pediatrics. Non-HIV antiviral Drugs. In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32^nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Itasca, IL 2021. p.930.
Rapivab (peramivir injection) for intravenous use. US Food & Drug Administration (FDA) approved product information. Revised January 2021. US Food & Drug Administration. Available at: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm (Accessed on February 3, 2021).
Xofluza (baloxavir marboxil) prescribing information. US Food and Drug Administration (FDA) approved product information. Revised August 2022. Available online at: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm (Accessed on August 16, 2022).

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Dosing recommendations for antiviral agents for the treatment of influenza in children and adolescents[1-3]

Dosing recommendations for antiviral agents for the treatment of influenza in children and adolescents^[1-3]