For children with influenza, should we choose oseltamivir or mabaloxavir?

Children are one of the high-risk groups for influenza A virus infection. Many parents know that when children get the flu, they usually use oseltamivir. Some parents found that they had the flu, and the doctor prescribed mabaloxavir. So can this medicine be given to children? What is the difference between it and oseltamivir?

Mabaloxavir is a prodrug that is converted into the active metabolite baloxavir by hydrolysis. Baloxavir inhibits the endonuclease activity of polymerase acid protein (an influenza virus-specific enzyme in the RNA polymerase complex required for viral gene transcription), thereby inhibiting influenza virus replication. Oseltamivir is a neuraminidase inhibitor that blocks neuraminidase activity and prevents the release of newly formed virus particles from the cell surface.

Simply put, compared to neuraminidase inhibitors such as oseltamivir, mabaloxavir works at an early stage of influenza virus reproduction, so the blocking speed may be faster.

The indications of Mabaloxavir in the instructions are "for patients aged 12 years and above with simple influenza A and B, including previously healthy patients and patients at high risk of influenza complications". However! China has approved the use of Mabaloxavir for simple influenza A and B patients aged 5 years and above, including previously healthy patients and patients at high risk of influenza complications. The delivery information of the drug approval document was released on March 23, 2023, but the drug instructions have not been modified yet.

In clinical trials conducted overseas, its safety and effectiveness in treating acute simple influenza were established in children aged 5 to 12 years.

For adults, adolescents, and children (≥5 years), take a single dose within 48 hours of symptom onset at the following dosage:

The Expert Consensus on Diagnosis and Treatment of Influenza in Children (2020 Edition) provides the dosage of oseltamivir for the treatment of influenza in children of all ages:

0-8 months: 3 mg/kg, twice a day;

9 to 11 months old: 3.5 mg/kg, twice a day.

The recommended dosage for children over 1 year old is as follows:

Therefore, pharmacists recommend that children under 5 years old can choose oseltamivir granules and oseltamivir dry suspension, which are more convenient for controlling dosage and taking. Children over 5 years old can choose oseltamivir capsules or mabaloxavir tablets (weight ≥ 20kg) in addition to the above two dosage forms. It should be noted that mabaloxavir can be taken with or without food, and should be avoided with dairy products, calcium-fortified beverages, laxatives containing high-valent cations, antacids or oral supplements (such as calcium, iron, magnesium, selenium or zinc).

Pharmacists remind you that oseltamivir and mabaloxavir are prescription drugs and must be used after diagnosis and evaluation by a doctor and prescription! Finally, during the peak period of influenza A epidemic, everyone should pay more attention to environmental hygiene and take good personal protection!

References

【1】 Medication assistant. “Sincere question: Can mabaloxavir be used for children with influenza?” Author: Pediatric Time

【2】 Oseltamivir instructions, Mabaloxavir instructions.

Academic authenticity, the author is responsible for the content

Source: Department of Pharmacy, Tianjin Children's Hospital

Author: Pharmacist Guo Xiaoliang