Table 1.

Antiviral drug indications and dosing

Drug	Indication	Route	Age	Dose
Ganciclovir	Induction therapy for CMV syndrome or CMV disease	IV	All ages	5 mg/kg every 12 h
	Maintenance therapy for CMV syndrome or CMV disease	IV	All ages	5 mg/kg every 24 h
	Prophylaxis against CMV infection	IV	All ages	Induction dosing for 7 d, followed by maintenance dosing
Valganciclovir	CMV disease (mild to moderate)	Oral	All ages	7 x BSA x CrCl (maximum dose 900 mg)
	Prophylaxis against CMV infection	Oral	≥4 mo to 16 y	7 x BSA x CrCl (maximum dose 900 mg)
Foscarnet	Induction therapy for CMV syndrome or CMV disease	IV	All ages	60 mg/kg every 12 h
	Maintenance therapy for CMV syndrome or CMV disease	IV	All ages	90 mg/kg once daily
	Prophylaxis against CMV infection	IV	All ages	Induction dosing for 7 d, followed by maintenance dosing
	HSV infection, acyclovir-resistant	IV	All ages	120 mg/kg/d divided every 8 or 12 h
	VZV infection, acyclovir-resistant	IV	All ages	80–120 mg/kg/d divided every 8 or 12 h
Cidofovir	Induction therapy for CMV syndrome or CMV disease	IV	All ages	5 mg/kg every week for 2 consecutive weeks, with hyperhydration ± probenecid
	Maintenance therapy for CMV syndrome or CMV disease	IV	All ages	5 mg/kg every 2 wk, with hyperhydration ± probenecid
	Adenovirus infection	IV	All ages	5 mg/kg every week, with hyperhydration ± probenecid
	HSV infection, acyclovir-resistant and foscarnet-resistant	IV	All ages	5 mg/kg every week for 2 wk, then every 2 wk, with hyperhydration ± probenecid
	VZV infection, acyclovir-resistant	IV	All ages	5 mg/kg every week, with hyperhydration ± probenecid
Letermovir	Prophylaxis against CMV infection	IV, Oral	≥18 y	480 mg every 24 h
Acyclovir	HSV infection (severe or disseminated disease)	IV	All ages	10 mg/kg every 8 h
	HSV infection (mild disease)	Oral	All ages	1000 mg/d, in 3–5 divided doses
	HSV encephalitis	IV	≥4 mo	500 mg/m2 every 8 h, or 10–15 mg/kg every 8 h
	Prophylaxis against HSV infection	IV	All ages	5 mg/kg every 8 h
		Oral	≥2 y	600–1000 mg/d, in 3–5 divided doses
	Varicella or varicella-zoster	IV	<2 y	10 mg/kg every 8 h
		IV	≥2 y	500 mg/m2 every 8 h, or 10 mg/kg every 8 h
Valacyclovir	HSV infection (mild localized infection disease)	Oral	≥2 y	20 mg/kg every 12 h (maximum dose 1000 mg)
	Prophylaxis against HSV infection	Oral	≥2 y	<40 kg: 250 mg every 12 h ≥40 kg: 500 mg every 12–24 h
	Varicella or varicella-zoster	Oral	≥2 y	20 mg/kg every 8 h (maximum dose 1000 mg)
	Prophylaxis against VZV infection	Oral	≥2 y	<40 kg: 250 mg every 12 h ≥40 kg: 500 mg every 12–24 h
	VZV postexposure prophylaxis	Oral	≥2 y	<40 kg: 500 mg every 8 h ≥40 kg: 1000 mg every 8 h
Oseltamivir	Treatment of influenza A and B infection	Oral	0–8 mo	3 mg/kg every 12 h
		Oral	9–11 mo	3.5 mg/kg every 12 h
		Oral	1–12 y	≤15 kg: 30 mg every 12 h 15-≤23 kg: 45 mg every 12 h 23-≤40 kg: 60 mg every 12 h >40 kg: 75 mg every 12 h
		Oral	≥13 y	75 mg every 12 h
	Prophylaxis against influenza A and B infection	Oral	≥3 mo	Same as treatment dose, except given once daily
		Oral
Baloxavir	Treatment of influenza A and B infection	Oral	≥12 y	40–80 kg: 40 mg
	Prophylaxis against influenza A and B infection			>80 kg: 80 mg
Peramivir	Treatment of influenza A and B infection	IV	≥2 y	12 mg/kg (maximum dose 600 mg)
Zanamivir	Treatment of influenza A and B infection	Inhaled	≥7 y	10 mg every 12 h
	Prophylaxis against influenza A and B infection	Inhaled	≥5 y	10 mg every 24 h
Ribavirin	Treatment of RSV infection	Inhaled	All ages	2000 mg every 8 h
		Oral	All ages	20 mg/kg/d divided 3 times per day (maximum dose 600 mg)

Data from the American Academy of Pediatrics. Non-HIV Antiviral Drugs. In: DW K, ed. Red Book: 2021–2024 Report of the Committee on Infectious Diseases: American Academy of Pediatrics; 2021:930–48; and Lexicomp Online. Pediatric and Neonatal Lexi-Drugs Online. July 30, 2021 ed. Waltham, MA: UpToDate, Inc; 2021