Protocole en version de travail pour l'Hôtel-Dieu de Lévis
ATTENTION CE PROTOCOLE N'EST PAS ADOPTÉ POUR USAGE À L'HÔTEL-DIEU DE LÉVIS
Adopté: NON
1 Oral oseltamivir is approved by the FDA for treatment of acute uncomplicated influenza with twice-daily dosing in persons 14 days and older, and for chemoprophylaxis with once-daily dosing in persons 1 year and older. Although not part of the FDA- approved indications, use of oral oseltamivir for treatment of influenza in infants less than 14 days old, and for chemoprophylaxis in infants 3 months to 1 year of age, is recommended by the CDC and the American Academy of Pediatrics (Committee on Infectious Diseases,2013).
2 This is the FDA-approved oral oseltamivir treatment dose for infants 14 days and older and less than 1 year old, and provides oseltamivir exposure in children similar to that achieved by the approved dose of 75 mg orally twice daily for adults, as shown in two studies of oseltamivir pharmacokinetics in children (Kimberlin, 2013 [CASG 114], EU study WP22849, FDA Clinical
Pharmacology Review). The American Academy of Pediatrics has recommended an oseltamivir treatment dose of 3.5 mg/kg
orally twice daily for infants aged 9-11 months for the 2013-14 season, on the basis of data which indicated that a higher dose of 3.5 mg/kg was needed to achieve theprotocol-defined targeted exposure for this cohort as defined in the CASG 114 study (Kimberlin, 2013). It is unknown whether this higher dose will improve efficacy or prevent the development of antiviral resistance. However, there is no evidence that the 3.5 mg/kg dose is harmful or causes more adverse events to infants in this age group.
3 Current weight-based dosing recommendations are not appropriate for premature infants. Premature infants might have slower clearance of oral oseltamivir because of immature renal function, and doses recommended for full-term infants might lead to very high drug concentrations in this age group. CDC recommends dosing as also recommended by the American Academy of Pediatrics (Committee on Infectious Diseases, 2013): limited data from the National Institute of Allergy and Infectious DiseasesCollaborative Antiviral Study Group provide the basis for dosing preterm infants using their postmenstrual age (gestational age + chronological age): 1.0 mg/kg/dose, orally, twice daily, for those <38 weeks postmenstrual age; 1.5 mg/kg/dose, orally, twice daily, for those 38 through 40 weeks postmenstrual age; 3.0 mg/kg/dose, orally, twice daily, for those
>40 weeks postmenstrual age.
4 Inhaled zanamivir is approved for treatment of acute uncomplicated influenza with twice-daily dosing in persons aged 7 years and older, and for chemoprophylaxis with once-daily dosing in persons aged 5 years and older.
Treatment
Chemo prophylaxis
Recommended duration for antiviral treatment is 5 days. Longer treatment courses for patients who remain severely ill after 5 days of treatment can be considered.
Recommended duration is 7 days (after last known exposure).
For control of outbreaks in institutional settings (e.g. long-term carefacilities for elderly persons and children) and hospitals, CDC recommends antiviral chemoprophylaxis for a minimum of 2 weeks, and continuing up to 1 week after the last known case was identified. Antiviral chemoprophylaxis should be considered for all exposed residents, including those who have received influenza vaccination, and for unvaccinated institutional employees.