Antiviral regimens for individual benefit in patients with nonsevere influenza
In these guidelines, nonsevere influenza is defined as patients with influenza who do not require ventilatory or haemodynamic support. For antiviral therapy for patients who require ventilatory or haemodynamic support, see Antiviral regimens for individual benefit in patients with severe influenza.
Antiviral therapy for influenza for individual benefit is only recommended for select patient groups. If indicated, useHayden, 2018Ison, 2020Adlhoch, 2023Dobson, 2015Heneghan, 2016Muthuri, 2014Walsh, 2022Katzen, 2019Venkatesan, 2020:
1oseltamivir orally, 12-hourly for 5 days. For dosage adjustment in adults with kidney impairment, see oseltamivir dosage adjustment oseltamivir oseltamivir oseltamivir
adult: 75 mg
child younger than 1 year: 3 mg/kg
child 1 year or older and less than 15 kg: 30 mg
child 1 year or older and 15 to less than 23 kg: 45 mg
child 1 year or older and 23 to 40 kg: 60 mg
child 1 year or older and more than 40 kg: 75 mg
OR
1baloxavir (adult or child 12 years or older) orally, as a single dose1 baloxavir baloxavir baloxavir
40 kg to less than 80 kg: 40 mg
80 kg or more: 80 mg
OR
2zanamivir (adult and child 5 years or older) 10 mg by inhalation, 12-hourly for 5 days. zanamivir zanamivir zanamivir
Continue empirical antiviral therapy despite a negative nucleic acid amplification test (NAAT) (eg polymerase chain reaction [PCR]) result if there is strong clinical suspicion for influenza (eg during an institutional outbreak).
For patients with influenza and immune compromise, consider extending the duration of oseltamivir or zanamivir treatment to 10 days. However, extended treatment can be associated with the development of resistance to neuraminidase inhibitors (usually oseltamivir).
For patients who do not improve, consider whether influenza is caused by antiviral-resistant strains and investigate for other potential causes (eg secondary bacterial infection with Streptococcus pneumoniae or Staphylococcus aureus).