ED Pathway for the Evaluation/Treatment of the Child with Flu

Oseltamivir (Tamiflu®) Treatment Guidelines

Oseltamivir is most beneficial if started within 48 hours of onset of symptoms.
However, it has been found to be effective (shorten length of illness, reduce hospitalizations, and decrease household transmission) if started up to 5 days of after onset of symptoms.

Oseltamivir Dosing Recommendations

Premature Neonates

Corrected Age: 24-37 weeks 1 mg/kg/dose twice daily for 5 days
Corrected Age: 38-41 weeks 6/7 days 1.5 mg/kg/dose twice daily for 5 days

Full Term Infants

0-13 days 1.5 mg/kg/dose twice daily for 5 days
2 weeks-3 months 3 mg/kg/dose twice daily for 5 days
3 months-< 1 year

Children 1-12 years

≤15 kg 30 mg twice daily for 5 days
>15-23 kg 45 mg twice daily for 5 days
>23-40 kg 60 mg twice daily for 5 days
>40 kg 75 mg twice daily for 5 days

Children >12 years and Adults

  75 mg twice daily for 5 days

Oseltamivir is FDA approved for the treatment of influenza in patients > 2 weeks of age. Dosing information for in premature neonates and full-term neonates up to 13 days of age are based on the literature and extrapolated.

Duration may need to be altered with recent vaccine receipt. Discuss questions with ID physician on call.

Chemoprophylaxis Guideline

CDC recommends prophylaxis in 4 clinical scenarios (most effective if started ≤ 48 hours since the last exposure to an infectious person):

Chemoprophylaxis Dose Recommendations

Premature Neonates

Corrected Age: 24-37 weeks not recommended unless situation is judged critical due to limited data on use in this age group *
Corrected Age: 38-41 weeks 6/7 days

Full Term Infants

0-13 days not recommended unless situation is judged critical due to limited data on use in this age group *
2 weeks-3 months
3 months-< 1 year 3 mg/kg/dose once daily for 7 days2

Children 1-12 years

≤15 kg 30 mg once daily for 7 days2
>15-23 kg 45 mg once daily for 7 days2
>23-40 kg 60 mg once daily for 7 days2
>40 kg 75 mg once daily for 7 days2

Children >12 years and Adults

  75 mg once daily for 7 days2

*Discuss any questions with ID Fellow on-call

  1. Antiviral chemoprophylaxis generally is not recommended if more than 48 hours have elapsed since the last exposure to an infectious person.
  2. Duration may need to be altered with recent vaccine receipt. For recent LAIV: chemoprophylaxis should not be given unless >2 weeks from vaccine receipt. For recent inactivated vaccine, continue prophylaxis through 2 weeks from vaccine receipt. Discuss questions with ID physician on call.