Children and Flu Antiviral Drugs

Antiviral Drugs

While getting a flu vaccine each year is recommended by CDC as the first and most important step in protecting against the flu, there also are drugs that can treat influenza. These are called “influenza antiviral drugs” and they are an important treatment option for the flu. (These drugs are not a substitute for vaccination, which can prevent flu illness.)

Antiviral drugs come in the form of pills, liquid or an inhaler. They fight the flu by keeping flu viruses from reproducing in the body. Antiviral drugs must be prescribed by a doctor — they are not available over-the-counter. For treatment, influenza antiviral drugs should ideally be started within 2 days after becoming sick and taken for 5 days. If a child gets sick with the flu, antiviral drugs offer a safe and effective treatment option.

Influenza antiviral drugs only work against influenza viruses — they will not help against other viruses that may cause illness symptoms similar to the flu.

Benefits from Antiviral Treatment of Influenza

Flu antiviral drugs can make flu symptoms milder and can shorten the duration of illness. Antiviral drugs work best if started soon after getting sick (within two days of symptoms starting). Early treatment of influenza with antiviral drugs has also been shown to reduce the incidence of ear infections and the need for antibiotics in children between the ages of 1 and 12 years old. Studies in outpatient adults show that treatment with antiviral drugs may reduce more serious flu-related complications like pneumonia and hospitalizations. While no such studies have been done on children, antiviral drugs may be similarly helpful for reducing more serious flu-related complications in children. Studies in both adults and children show that treatment of hospitalized patients is beneficial in preventing respiratory failure and death.

CDC and the American Academy of Pediatrics (AAP) recommend antiviral drugs to treat confirmed or suspected influenza in children with severe, complicated, or progressive illness, or who are hospitalized with confirmed or suspected influenza. Treatment is also recommended for children who are at higher risk of serious flu-related complications and influenza infection of any severity. Children at high risk of flu-related complications include children younger than 5 years old (especially those younger than 2 years) and children of any age with chronic health conditions like asthma, diabetes, or heart or lung disease. For more information on the AAP recommendations, visit the AAP’s Red Book Online Influenza Resource Page.

Antiviral Drugs Approved for Use in Children

There are four influenza antiviral drugs approved by the FDA for use in the United States, and two are recommended for use during the 2014-2015 flu season:

• Oseltamivir (Tamiflu®) is approved for treatment of influenza in children 2 weeks of age or older. It is approved for prevention of influenza in children 1 year of age or older. Oral oseltamivir comes in the form of pills and liquid.
• Zanamivir (Relenza®) is approved for treatment of influenza in children 7 years and older, and is approved for prevention of influenza in children 5 years and older. It is not recommended for use in people with underlying respiratory or heart disease, including people with asthma. Inhaled zanamivir is given via a special inhaler (Diskhaler®).

Two other approved drugs are amantadine (Symmetrel®) and rimantadine (Flumandine®), but these are not currently recommended for the treatment or prevention of influenza infection because flu viruses in recent years have shown a high level of resistance to these drugs (meaning that the virus can reproduce even when these drugs are used).  Top of Page

Side Effects of Antiviral Drugs

Reported side effects of oral oseltamivir are nausea and vomiting. Among children treated with oseltamivir in clinical studies, 14% had vomiting, compared with 8.5% of children getting a “placebo.” (A placebo is an inactive substance that looks the same as, and is given in the same way as, a drug in a clinical trial.) Nausea and vomiting might be less severe if oseltamivir is taken with food. In addition, there have been reports of self-injury or delirium among persons with influenza who take oseltamivir. Most of these reports have been in teenagers from Japan, and it is not certain whether oseltamivir or the influenza virus was responsible for these behavior changes. Several recent reports have found that oral oseltamivir is not associated with an increased risk of such events.

Side effects from inhaled zanamivir have been reported in fewer than 5% of people participating in clinical trials and have been reported at the same rate in people receiving zanamivir as those being given a “placebo.” Reported side effects have included diarrhea, nausea, sinusitis, nasal signs and symptoms, bronchitis, cough, headache, dizziness, and ear, nose, and throat infections. Also, zanamivir should not be used in people with underlying respiratory disease, including asthma.

If Your Child Gets the Flu

Your child’s health care provider can help decide whether your child should take antiviral drugs if they get the flu this season. Flu-like symptoms include fever (usually high), headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose and muscle aches.

For more information about influenza antiviral drugs, visit Treatment - Antiviral Drugs.