Avian Influenza (Bird Flu) Medication

Updated: Feb 12, 2020
  • Author: Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab); Chief Editor: Michael Stuart Bronze, MD  more...
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Medication Summary

Current WHO and CDC guidelines recommend treatment regimens with a neuraminidase inhibitor, preferably oseltamivir. Studies are ongoing as to the relative effectiveness of high-dose and/or prolonged courses of therapy with oseltamivir. [14] If high-dose regimens prove to be more effective, the availability of antiviral medication in the event of a massive outbreak, as well as treatment considerations for mildly versus severely ill people, would be affected.

Zanamivir has not yet been tested in people with H5N1 disease, but animal studies are promising and the resistance mutations to oseltamivir do not cause cross-resistance. Some researchers have recommended dual therapy with both existing neuraminidase inhibitors. One concern is that inhaled zanamivir is unlikely to reach distal airways in severe disease. [14]

Currently, the CDC is recommending against using the M2 ion-channel blockers amantadine and rimantadine for routine influenza treatment or prophylaxis because of increasing resistance rates. [18]


Antivirals, Influenza

Class Summary

Agents that inhibit neuraminidase activity may be of benefit.

Oseltamivir (Tamiflu)

Inhibits neuraminidase, which is a glycoprotein on the surface of influenza virus that destroys an infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, decreases release of viruses from infected cells and thus viral spread. Effective to treat influenza A or B. For hospitalized patients and outpatients with severe, complicated, or progressive illness (eg, development of pneumonia), treatment with oral or enterically administered oseltamivir is recommended. Start within 40 h of symptom onset. Available as cap (75 mg, 45 mg, 30 mg) and oral susp.

Zanamivir (Relenza)

Inhibitor of neuraminidase, which is a glycoprotein on the surface of the influenza virus that destroys the infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, release of viruses from infected cells and viral spread are decreased. Effective against both influenza A and B. Consider use for outpatients without underlying asthma or COPD. Administer by inhalation via Diskhaler oral inhalation device. Circular foil discs containing 5-mg blisters of drug are inserted into supplied inhalation device. IV zanamivir is investigational and is available as compassionate use for severe influenza in hospitalized adults or children.

Peramivir (Rapivab)

Neuraminidase inhibitor. It is indicated for treatment of acute uncomplicated influenza in patients aged 6 months and older who have been symptomatic for less than 2 days. Peramivir is used in hospitalized patients and administered as an IV infusion.


Vaccines, Inactivated, Viral

Influenza A (H5N1) vaccine (Audenz)

Indicated for active immunization to prevent disease caused by the influenza A virus H5N1 subtype in patients aged 6 months or older who are at increased risk of exposure.