Antiviral options for treatment of influenza
| Antiviral agent . | Susceptibility . | Recommended dosing and duration in patients with hematologic malignancies . | Key toxicities . | Parenteral formulation available . | ||||
|---|---|---|---|---|---|---|---|---|
| 2009 H1N1 . | 2008/9 seasonal H1N1 . | 2008/9 seasonal H3N2 . | Influenza B or C . | Adults . | Children . | |||
| Oseltamivir | Yes | No | Yes | Yes | Treatment: 150 mg PO twice daily × 10 d*; postexposure prophylaxis: 75 mg PO once or twice daily × 10 d*; seasonal prophylaxis: 75 mg PO once daily | Dosing guidelines: see CDC guidelines: http://www.cdc.gov/A/H1N1flu/recommendations.htm36 ; care to be taken in dosing children < 1 y, with dose of 3-3.5 mg/kg/dose recommended | Gastrointestinal: greatly reduced if oral drug taken with food; Neurologic (children) | Yes (investigational, phase 1) |
| Zanamivir | Yes | Yes | Yes | Yes | Treatment: 10 mg twice daily (by inhaler); after exposure: 10 mg twice daily (by inhaler); prophylaxis: 10 mg twice daily (by inhaler) | Not available for children < 7 y; for children > 7 y, use adult doses | Bronchospasm | Yes (investigational, phase 2) |
| Rimantidine (amantidine) | No | Yes | No | No | Treatment: 100 mg PO twice daily | Age 1-10 y: 5 mg/kg per day PO, 1-2 divided doses, max 150 mg/day; age ≥ 10 y: 100 mg PO twice daily | Neurologic Gastrointestinal | No |
| Ribavirin | Not recommended as monotherapy37 | Not recommended as monotherapy37 | Not recommended as monotherapy37 | Not recommended as monotherapy37 | Treatment: 200-400 mg PO 3× daily† | No dosing guidelines available | Hematologic Gastrointestinal | Yes (investigational in the US) |
| Peramivir | Yes | No | Yes | Yes | Treatment: 600 mg IV once daily | Up to 30 d: 6 mg/kg; 31-90 d: 8 mg/kg; 91-180 d: 10 mg/kg; 181 d to 5 y: 12 mg/kg; 6-17 y: 10 mg/kg (maximum 600 mg/day) | Gastrointestinal; Neutropenia | Yes (EUA in the US) |
| Antiviral agent . | Susceptibility . | Recommended dosing and duration in patients with hematologic malignancies . | Key toxicities . | Parenteral formulation available . | ||||
|---|---|---|---|---|---|---|---|---|
| 2009 H1N1 . | 2008/9 seasonal H1N1 . | 2008/9 seasonal H3N2 . | Influenza B or C . | Adults . | Children . | |||
| Oseltamivir | Yes | No | Yes | Yes | Treatment: 150 mg PO twice daily × 10 d*; postexposure prophylaxis: 75 mg PO once or twice daily × 10 d*; seasonal prophylaxis: 75 mg PO once daily | Dosing guidelines: see CDC guidelines: http://www.cdc.gov/A/H1N1flu/recommendations.htm36 ; care to be taken in dosing children < 1 y, with dose of 3-3.5 mg/kg/dose recommended | Gastrointestinal: greatly reduced if oral drug taken with food; Neurologic (children) | Yes (investigational, phase 1) |
| Zanamivir | Yes | Yes | Yes | Yes | Treatment: 10 mg twice daily (by inhaler); after exposure: 10 mg twice daily (by inhaler); prophylaxis: 10 mg twice daily (by inhaler) | Not available for children < 7 y; for children > 7 y, use adult doses | Bronchospasm | Yes (investigational, phase 2) |
| Rimantidine (amantidine) | No | Yes | No | No | Treatment: 100 mg PO twice daily | Age 1-10 y: 5 mg/kg per day PO, 1-2 divided doses, max 150 mg/day; age ≥ 10 y: 100 mg PO twice daily | Neurologic Gastrointestinal | No |
| Ribavirin | Not recommended as monotherapy37 | Not recommended as monotherapy37 | Not recommended as monotherapy37 | Not recommended as monotherapy37 | Treatment: 200-400 mg PO 3× daily† | No dosing guidelines available | Hematologic Gastrointestinal | Yes (investigational in the US) |
| Peramivir | Yes | No | Yes | Yes | Treatment: 600 mg IV once daily | Up to 30 d: 6 mg/kg; 31-90 d: 8 mg/kg; 91-180 d: 10 mg/kg; 181 d to 5 y: 12 mg/kg; 6-17 y: 10 mg/kg (maximum 600 mg/day) | Gastrointestinal; Neutropenia | Yes (EUA in the US) |
All doses stated are for patients with normal renal function. Dose reductions may be necessary in patients with reduced renal clearance.
PO indicates by mouth; IV, intravenous; and EUA, emergency use authorization (granted by US Food and Drug Administration).
Authors' recommendation; see “Management of upper and lower respiratory infection” for rationale.
Dose estimated from published case series.38-40