Influenza Antiviral Medications


CDC Antiviral Recommendations for the 2014-2015 Season


Antiviral medications with activity against influenza viruses are an important adjunct to influenza vaccine in the control of influenza.

Three prescription neuraminidase inhibitor antiviral medications are approved by the U.S. Food and Drug Administration (FDA) and are recommended for use in the United States during the 2014-2015 influenza season: oseltamivir (Tamiflu®), zanamivir (Relenza®), and peramivir (Rapivab®).

Timing of Treatment and Implications for Patient Evaluation, Treatment and Testing

Clinical benefit is greatest when antiviral treatment is administered early in the illness course. When indicated, antiviral treatment should be started as soon as possible after illness onset and should not be delayed even for a few hours to wait for the results of testing. Ideally, treatment should be initiated within 48 hours of symptom onset. However, antiviral treatment initiated later than 48 hours after illness onset can still be beneficial for some patients. Observational studies of hospitalized patients suggest that while the greatest benefit occurs when antiviral treatment is initiated within 48 hours of illness onset, treatment might still be beneficial when initiated up to 4 or 5 days after symptom onset. Also, a randomized placebo controlled study suggested clinical benefit when oseltamivir was initiated 72 hours after illness onset among febrile children with uncomplicated influenza. Clinical judgment, on the basis of
the patient’s disease severity and progression, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms, is important when making antiviral treatment decisions for outpatients.

CDC Antiviral Recommendations for the 2014-2015 Season


CDC recommends antiviral medications for treatment of influenza as an important adjunct to annual influenza vaccination. Treatment with neuraminidase inhibitors has been shown to have clinical and public health benefit in reducing illness and severe outcomes of influenza, as evidenced from randomized controlled trials, meta-analyses of randomized controlled trials, and observational studies of oral oseltamivir, inhaled zanamivir, or parenteral peramivir treatment during past influenza seasons and during the 2009 H1N1 pandemic.

All Hospitalized, Severely ill, and High Risk Patients with Suspected Influenza Should Be Treated with Antivirals

Any patient with suspected or confirmed influenza in the following categories should be treated with a neuraminidase inhibitor:

1) Hospitalized – treatment is recommended for all hospitalized patients
2) Severe, complicated, or progressive illness – this may include outpatients with severe or prolonged     progressive symptoms or who develop complications such as pneumonia
3) Higher risk for influenza complications (hospitalized or outpatient) – patients in this group include:

    • children younger than 2 years (although all children younger than 5 years are considered at higher risk for complications from influenza, the highest risk is for those younger than 2 years);
    • adults aged 65 years and older;
    • persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), and metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe developmental delay, muscular dystrophy, or spinal cord injury);
    • persons with immunosuppression, including that caused by medications or by HIV infection;
    • women who are pregnant or postpartum (within 2 weeks after delivery);
    • persons aged younger than 19 years who are receiving long-term aspirin therapy;
    • American Indians/Alaska Natives;
    • persons who are morbidly obese (i.e., body-mass index is equal to or greater than 40); and
    • residents of nursing homes and other chronic-care facilities.


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