Interim Guidance for Clinicians to Prioritize Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir

The Centers for Disease Control and Prevention (CDC) issued a Health Advisory to provide guidance on antiviral treatment of influenza in the setting of reduced availability of oseltamivir.

The the Food and Drug Administration (FDA) has not indicated shortages of oseltamivir (generic or Tamiflu) in any of its forms (capsules, oral suspension). CDC has received numerous anecdotal reports of availability issues for generic oseltamivir in some locations; however, the CDC provides guidance for prioritizing oseltamivir for treatment and information on other influenza antivirals that are recommended for treating influenza in areas where oseltamivir is temporarily unavailable.

General Recommendations for Clinicians and Public Health Practitioners

If available, brand-name oseltamivir (Tamiflu) can be used to treat outpatients and hospitalized patients with influenza.
If oseltamivir is unavailable, oral baloxavir, inhaled zanamivir, or intravenous peramivir can be used for early treatment of outpatients at increased risk for complications who present with uncomplicated influenza, depending upon age and contraindications.
When there is limited availability of oseltamivir or other antivirals, antiviral treatment should target patients with influenza who are at the highest risk of severe disease and those who are hospitalized.
Antiviral treatment of outpatients should be prioritized for persons who test positive for influenza within 2 days of illness onset.
When there is limited availability of oseltamivir or other antivirals, patients with clinically mild influenza who are otherwise healthy and not at increased risk of influenza complications can be managed with supportive care without antiviral treatment.

Hospitalized Patients

Prioritize oseltamivir treatment as soon as possible for hospitalized patients with suspected or laboratory-confirmed influenza.

Outpatients

Patients at increased risk of influenza complications and who test positive for influenza within 2 days of illness onset.
Patients who have progressive or severe influenza not requiring hospitalization, even if they test positive for influenza more than 2 days from illness onset.
Patients who are pregnant, less than 2 weeks postpartum, or immunocompromised.
Children less than 5 years of age.

For more information, please consult the complete CDC Health Advisory .