Choice of agent according to clinical characteristics | ||
Patient group | Preferred agent(s) | Alternative agent |
Children with severe illness | ||
Any of the following:
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Children with nonsevere illness | ||
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Considerations in choice of agent in children with nonsevere illness | ||
Agent | Advantages | Disadvantages |
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IV: intravenous; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; OG: orogastric; NG: nasogastric.
* May be administered via OG or NG tube, although pharmacokinetics may differ from oral administration, resulting in decreased concentrations.
¶ Oseltamivir resistance has been reported among children and immunocompromised patients during treatment with oseltamivir, predominantly among immunocompromised patients with influenza A(H1N1)pdm09 virus infection.
Δ Clinical trials directly comparing the antiviral agents listed above with 1 another in children are generally lacking (with the exception of 2 trials comparing oseltamivir and baloxavir[2,3]). However, in a network meta-analysis that estimated the relative efficacy of different antiviral agents (oseltamivir, zanamivir, peramivir, and baloxavir) based upon indirect comparisons from placebo-controlled and oseltamivir-controlled trials (most trials involved adult patients managed in the outpatient setting), zanamivir therapy was associated with the shortest duration of symptoms and baloxavir therapy was associated with the lowest risk of complications[4]. The certainty of these findings is low. The network meta-analysis did not include one of the trials that compared baloxavir and oseltamivir[3].
◊ Baloxavir has been associated with treatment-emergent resistance, particularly when influenza A(H3N2) viruses were circulating. In clinical trials, escape mutants (virus with mutations with decreased susceptibility to baloxavir) were detected in approximately 15 to 20% of young patients (ie, <12 years old) treated with baloxavir and approximately 5 to 10% of older baloxavir recipients.Do you want to add Medilib to your home screen?