CDC Updates Antiviral Drug Guidelines for Flu Season

November 2009

By Heidi Splete
Elsevier Global Medical News 

The Centers for Disease Control and Prevention has updated its guidelines for using antiviral medications to treat the seasonal and pandemic influenza A(H1N1) viruses, according to the CDC Web site.

The updated recommendations include guidance for clinicians about antiviral treatment for very young children, information about correct dosing using the oseltamivir (Tamiflu) dosing dispenser, and recommendations for antiviral treatment for patients who have neurocognitive and neuromuscular disorders.

  • Treating children younger than age 1 year. Oseltamivir is not approved by the Food and Drug Administration for use in children younger than 1 year of age. But given this age group's increased risk for complications from the H1N1 virus, the CDC recommends a 5-day antiviral treatment dose with oseltamivir of 25 mg twice daily for children aged 6-11 months, 20 mg twice daily for children aged 3-5 months, and 12 mg twice daily for children younger than 3 months.

The CDC's recommendations for 10-day prophylaxis with oseltamivir are 25 mg once daily for children aged 6-11 months, 20 mg once daily for children aged 3-5 months, but oseltamivir is not currently recommended for prophylaxis for children younger than 3 months unless the situation is deemed critical.

The FDA issued an Emergency Use Authorization in April 2009 for the emergency use of oseltamivir in children younger than 1 year old.

  • Dispenser measurements. The updated CDC antiviral recommendations caution clinicians and pharmacists that an oral dosing dispenser that comes with Tamiflu for oral suspension shows dose measurements in 30-mg, 45-mg, and 60-mg increments. These measurements use mg and match those currently recommended by the CDC for treatment or chemoprophylaxis against H1N1 infection, but the prescription instructions may be listed in mL or tsp, which can lead to dosing errors.
  • Patients with neuromuscular or neurocognitive disorders. The revised recommendations for patients who might benefit most from early treatment with antiviral therapy include patients with disorders that increase the risk of aspiration, such as spinal cord injury, seizure disorders, cognitive dysfunction, and other neuromuscular disorders, plus any disorders that "can compromise respiratory function or the handling of respiratory secretions."

The CDC Web site states that the recommendations should be considered an interim document, which will be updated as needed. For the latest information on the CDC's flu guidance and recommendations, visit or


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