CLINICAL REPORT Antiviral Therapy and Prophylaxis for Influenza in Children

Antiviral agents are available that are safe and effective for the treatment and prophylaxis of influenza virus infections in children. The neuraminidase inhibitors (oseltamivir [Tamiflu] and zanamivir [Relenza]) are preferred agents because of current widespread resistance to the adamantanes (amantadine [Symmetrel] and rimantadine [Flumadine]). Therapy should be provided to children with influenza infection who are at high risk of severe infection and to children with moderateto-severe influenza infection who may benefit from a decrease in the duration of symptoms. Prophylaxis should be provided (1) to high-risk children who have not yet received immunization and during the 2 weeks after immunization, (2) to unimmunized family members and health care professionals with close contact with high-risk unimmunized children or infants who are younger than 6 months, and (3) for control of influenza outbreaks in unimmunized staff and children in an institutional setting. Testing of current H5N1 avian influenza virus isolates, the potential agents of pandemic influenza, suggests susceptibility to oseltamivir and zanamivir. Because no prospective data exist on the efficacy of these agents in humans for H5N1 strains, the dosage and duration of therapy in adults and children may differ from those documented to be effective for epidemic influenza strains. INTRODUCTION Antiviral agents for treatment and prophylaxis of influenza are safe and effective in children. Annual immunization against influenza is the preferred strategy for prevention of infection, but certain situations exist in which the use of antiviral agents is beneficial. The morbidity and mortality of epidemic influenza in unimmunized children is substantial, particularly in those younger than 2 years.1–5 The purpose of this report is to offer guidance regarding antiviral treatment and prophylaxis to clinicians caring for children during yearly influenza epidemics and to provide resources for information on antiviral treatment in the event of an influenza pandemic, because no prospective human data currently exist on which to base recommendations for treatment of infections caused by potential H5N1 pandemic influenza virus strains. ANTIVIRAL DRUGS FOR EPIDEMIC AND PANDEMIC INFLUENZA Two classes of antiviral medications are currently available for treatment or prophylaxis of influenza infections: neuraminidase inhibitors (NAIs) (oseltamivir [Tamiflu; Roche Laboratories, Nutley, NJ] and zanamivir [Relenza; GlaxoSmithKline, Research Triangle Park, NC]) and the adamantanes (amantadine [Symmewww.pediatrics.org/cgi/doi/10.1542/ peds.2007-0224 doi:10.1542/peds.2007-0224 All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.