Influenza%20(pediatric) Treatment

• Option for the control of influenza, but should not be used as a substitute to influenza vaccination

Prophylaxis

• Antiviral agents (eg Baloxavir marboxil, Oseltamivir, Zanamivir) may be used to prevent spread of influenza among unvaccinated high-risk household members and during an influenza outbreak in an institutionalized setting
• May be used in persons who cannot be vaccinated due to contraindications to vaccine
  • Do not start until influenza epidemic has begun and stop only when epidemic is over
• May be used in persons at high risk for complications who have been vaccinated after an outbreak of influenza has begun
  • Give for 2 weeks starting from day of vaccination to give sufficient time for immunity to develop
• Postexposure chemoprophylaxis should only be used if agents can be given within 48 hours of exposure

Treatment

• When used within 48 hours of symptom onset, antiviral agents may reduce the duration of symptoms
  • Should not be used if there is uncertainty about diagnosis or if bacterial infection cannot be ruled out
  • Administration of antiviral treatment may be considered in very ill or high-risk suspected influenza patients even without confirmed tests if:
    • Currently admitted
    • Categorized as severe, complicated, or with progressive disease
    • At high risk for complications (ie immunocompromised, <2 years of age, with comorbidities)
    • Receiving long-term Aspirin treatment
• None of the following agents have been shown to be effective in preventing serious influenza-related complications
• Data is limited concerning effectiveness of the antiviral agents for the treatment of patients at high risk of serious complications of influenza

Adamantanes

• Eg Amantadine, Rimantadine
• Consider local resistance data when prescribing adamantanes for patients with influenza
• Chemoprophylaxis and treatment against circulating influenza A virus strains using adamantanes are not recommended because of increasing reports of drug resistance
• Possesses little or no activity against influenza type B virus

Baloxavir marboxil

• The 1st approved influenza virus-specific enzyme polymerase acidic (PA) protein-targeting drug used for the treatment of acute uncomplicated seasonal influenza in patients ≥12 years old at high risk of developing complications and in otherwise healthy children ≥5 years old who exhibited symptoms for no more than 48 hours
• May also be used as a single-dose post-exposure prophylaxis agent in children ≥12 years of age
• Based on several studies, the therapeutic effect of a single dose of Baloxavir marboxil is comparable to that of the 5-day twice-daily treatment with Oseltamivir

Neuraminidase Inhibitors

• Eg Oseltamivir, Peramivir, Zanamivir
• Oral Oseltamivir and inhaled Zanamivir are used for treatment and prophylaxis of infection with influenza A or B viruses
  • Oral Oseltamivir is the antiviral drug of choice for the management of influenza infections in children
    • May be given to premature infants at 3-3.5 mg/kg/dose 12 hourly
  • Inhaled Zanamivir may be used in children ≥7 years old as an alternative treatment for those without any chronic lung disease
• Intravenous Peramivir can be used for early treatment of acute uncomplicated influenza in nonhospitalized children ≥2 years of age who have been symptomatic for no more than 48 hours
• Studies are still being conducted on the use of intravenous Zanamivir for seasonal influenza but may be considered in newly emergent Oseltamivir- or Peramivir-resistant virus
• Effects:
  • As treatment: Can reduce duration of uncomplicated influenza A and B illness by approximately 1 day compared with placebo when used within 2 days of illness onset
  • Both drugs are effective, 82% (Oseltamivir) or 84% (Zanamivir), in preventing febrile, laboratory-confirmed influenza illness in otherwise healthy individuals
• Combination treatment with neuraminidase inhibitors is not recommended