This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Dosing Recommendations for Antiviral Agents for Treatment and Prophylaxis of Influenza

^a Amantadine and rimantadine should only be used for prophylaxis in winter seasons during which a majority of influenza A virus strains isolated are adamantine-susceptible; the adamantanes should not be used for primary therapy because of the rapid emergence of resistance. However, for those requiring adamantine therapy, a treatment course of approximately 7 days is suggested, or 24 to 48 hours after the disappearance of signs and symptoms.

^b For prophylaxis, antiviral drugs should be continued for the duration of known influenza A in the community because of the potential for repeated and unknown exposures or until immunity can be achieved after immunization.

Indications for Therapy and Prophylaxis

Therapy

• Influenza infection of any severity in high-risk children (see definition of "high-risk" below) regardless of immunization status
• Any otherwise healthy child with moderate-to-severe influenza infection who may benefit from the decrease in duration of clinical symptoms documented to occur with therapy

Prophylaxis

• High-risk children during the 2 weeks after influenza immunization, if influenza is active in the community
• High-risk children for whom influenza vaccine is contraindicated
• Family members or health care providers who are unimmunized and are likely to have ongoing, close exposure to (1) high-risk, unimmunized children or (2) infants who are younger than 6 months
• Control of influenza outbreaks for unimmunized staff and children in a closed institutional setting with high-risk pediatric residents (e.g., extended-care facilities)
• As a supplement to immunization among high-risk children
• Postexposure prophylaxis in a family setting
• High-risk children and their family members and close contacts, as well as health care workers, when circulating strains of influenza virus in the community are not matched with vaccine strains

Infants And Children at High Risk of Complications From Influenza Include Those with:

• Ages between 6 and 24 months (no antiviral agent is currently approved for infants younger than 12 months)
• Asthma or other chronic pulmonary diseases such as cystic fibrosis
• Hemodynamically significant cardiac disease
• Immunosuppressive disorders or therapy
• Human immunodeficiency virus (HIV) infection
• Sickle cell anemia and other hemoglobinopathies
• Diseases requiring long-term aspirin therapy, such as rheumatoid arthritis or Kawasaki disease
• Chronic renal dysfunction
• Chronic metabolic disease such as diabetes mellitus
• Neuromuscular disorders, seizure disorders, or cognitive dysfunction that may compromise the handling of respiratory secretions

None provided

The type of evidence supporting the recommendations is not specifically stated.

Not applicable: The guideline was not adapted from another source.

2007 Apr

American Academy of Pediatrics - Medical Specialty Society

American Academy of Pediatrics

Committee on Infectious Diseases

Committee on Infectious Diseases, 2006-2007: Joseph A. Bocchini, Jr, MD, Chairperson; Robert S. Baltimore, MD; Henry H. Bernstein, DO; John S. Bradley, MD; Michael T. Brady, MD; Penelope H. Dennehy, MD; Margaret C. Fisher, MD; Robert W. Frenck, Jr, MD; David W. Kimberlin, MD; Sarah S. Long, MD; Julia A. McMillan, MD; Lorry G. Rubin, MD

Liaisons: Richard D. Clover, MD, American Academy of Family Physicians; Marc A. Fischer, MD, Centers for Disease Control and Prevention; Richard L. Gorman, MD, National Institutes of Health; Douglas R. Pratt, MD, Food and Drug Administration; Anne Schuchat, MD, Centers for Disease Control and Prevention; Benjamin Schwartz, MD, National Vaccine Program Office; Jeffrey R. Starke, MD, American Thoracic Society; Jack Swanson, MD, Practice Action Group

Ex Officio: Larry K. Pickering, MD, Red Book Editor; Carol J. Baker, MD, Red Book Associate Editor

Consultant: Edgar O. Ledbetter, MD

Staff: Alison Siwek, MPH

Not stated

This is the current release of the guideline.

All clinical reports and policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

None available

None available

This NGC summary was completed by ECRI Institute on May 15, 2007. The information was verified by the guideline developer on May 23, 2007. This summary was updated by ECRI Institute on March 10, 2008 following the U.S. Food and Drug Administration (FDA) advisory on Tamiflu (oseltamivir phosphate). This summary was updated by ECRI Institute on April 9, 2008 following the U.S. Food and Drug Administration (FDA) advisory on Relenza (zanamivir).

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.