Pediatric Guidelines: Viral Infections - Influenza

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments


Click here for detailed influenza guidelines including treatment indications for BCH UCSF

Influenza virus

Oseltamivir according to body weight:

Preterm infants: Contact Pediatric ID/ASP

Zanamivir can be used for children age >= 7 years old for treatment or >= 5 years old for prophylaxis - consider in patients unable to tolerate PO but able to use dry powder inhaler:

Zanamivir 10mg/dose (2 inhalations) INH BID


Treatment, most patients: 5 days*

Prophylaxis: 7 days

Oseltamivir Dosing for Prophylaxis (most effective if initiated within 48-72 hours of exposure: 

Age < 3 months: not recommended

Term infants 0-8 months:

3mg/kg/dose PO BID

Infants 3-8 months:

3mg/kg/dose PO daily

Infants 9-11 months:

3.5mg/kg/dose PO BID

Infants 9-11 months:

3.5mg/kg/dose PO daily

Children >=12 months:

<=15kg: 30mg/dose PO BID

>15-23kg: 45mg/dose PO BID

>23-40kg: 60mg/dose PO BID

>40kg: 75mg/dose PO BID

Children >= 12 months: 

<=15kg: 30mg/dose PO daily

>15-23kg: 45mg/dose PO daily

>23-40kg: 60mg/dose PO daily

>40kg: 75mg/dose PO daily



7 days


5 days for most patients*

Consult Pediatric ID for use of Peramivir in critically ill patients unable to take PO or dry powder inhaler


*For ICU patients, longer courses (e.g. 10 days) may be considered based on severity of illness and repeat RVP testing of lower respiratory tract samples. Please consult ID for assistance in these cases.



American Academy of Pediatrics, Committee on Infectious Diseases. Recommendations for prevention and control of influenza, 2015-2016. Pediatrics 2015;136:792-808.

Centers for Disease Control and Prevention. Antiviral agents for the treatment and chemoprophylaxis of influenza: Recommendations from the Advisory Committee on Immunization Practices. Morbid Mortal Wkly Rep 2011;60(1):1-18.  

CDC Influenza Antiviral Medications: Summary for Clinicians

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).