use standard dose enteric oseltamivir without adjusting for weight

Patients should be treated with neuraminidase inhibitors and sialic acid analogues that prevent new virions from being released from cells, in addition to evidence-based management for ARDS. Approved agents for influenza include oseltamivir, peramivir, and zanamivir. Observational studies and meta-analyses have reported mortality benefit with neuraminidase inhibitors compared with placebo in hospitalized patients, with oseltamivir being used in the majority of studies. Benefits are greatest when treatment is started within 48 h of illness onset, and even though guidelines recommend initiation of therapy within this time frame, treatment still has benefit when initiated outside this window. Baloxavir, a cap-dependent endonuclease, is also approved for treatment.

Enteric oseltamivir is an effective treatment for patients who are critically ill, and studies have demonstrated that appropriate plasma concentrations are achieved when administered via nasogastric tube in patients in the ICU. Similarly, therapeutic concentrations of oseltamivir are found in individuals with and without obesity who are treated with the drug; therefore, Infectious Diseases Society of America guidelines recommend standard oseltamivir dosing regardless of BMI in adults.12345

Footnotes

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  2. Ariano RE, Sitar DS, Zelenitsky SA, et al. Enteric absorption and pharmacokinetics of oseltamivir in critically ill patients with pandemic (H1N1) influenza. CMAJ. 2010;182(4):357-363. PubMed ↩

  3. Muthuri SG, Venkatesan S, Myles PR, et al; PRIDE Consortium Investigators. Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respir Med. 2014;2(5):395-404. PubMed ↩

  4. Pai MP, Lodise TP Jr. Oseltamivir and oseltamivir carboxylate pharmacokinetics in obese adults: dose modification for weight is not necessary. Antimicrob Agents Chemother. 2011;55(12):5640-5645. PubMed ↩

  5. Uyeki TM, Bernstein HH, Bradley JS, et al. Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clin Infect Dis. 2019;68(6):e1-e47. PubMed ↩