Medications used in the treatment for viral pneumonia
| Medication | Uses | Special consideration | |
| Oseltamivir | Influenza pneumonia and uncomplicated influenza infection | Oral 75 mg twice daily for 5 days *Consider longer duration for critically ill patients | Needs dose adjustment for renal impairment, CrCl<50 |
| Peramivir | Uncomplicated influenza infection | Intravenous 600 mg single dose *Consider repeated daily dosage up to 5 days for complicated influenza infection | Efficacy not established for serious influenza infection and influenza B Needs dose adjustment for renal impairment (CrCl)<50 |
| Zanamivir | Uncomplicated influenza infection | *Intravenous zanamivir investigational drug, available for clinical use for oseltamivir-resistant influenza strains | Inhaled form is not recommended for influenza pneumonia |
| Ribavirin | *Mostly used for RSV infection in immunocompromised, used anecdotally for severe PIV and HMPV infection | *Aerosolized 2 g over 2 hours every 8 hours±intravenous immunoglobulin | Logistically difficult to administer In mechanically ventilated patients, can deposit in the ventilator delivery system leading to malfunction |
| *Systemic oral or intravenous (dosage variable)±intravenous immunoglobulin | Hemolytic anemia Teratogenic, requires special drug handling for HCW | ||
| Cidofovir | *Severe adenovirus infection in immunocompromised and immunocompetent patients | *Intravenous 5 mg/kg/dose weekly, duration of therapy variable, usually until symptoms resolve | Nephrotoxicity is a major toxicity, given concomitantly with intravenous hydration and oral probenecid 2 g 3 hours prior to infusion then 1 g at 2 hours and 8 hours after completion of the infusion Contraindicated with pre-existing renal disease CrCl<55 |
| Acyclovir | Varicella pneumonitis | Intravenous 10 mg/kg/dose every 8 hours for at least 7 days | Neurotoxicity and nephrotoxicity Needs dose adjustment for CrCl<50 Neurotoxicity may be more common in patients with renal impairment |
| Ganciclovir | *CMV pneumonitis | Intravenous 5 mg/kg/dose every 12 hours for at least 2 weeks | Hematological toxicity (anemia, thrombocytopenia, leucopenia), nephrotoxicity and gastrointestinal symptom Needs dose adjustment for CrCl<70 |
*Off-label use.
CMV, cytomegalovirus; CrCl, creatinine clearance; HCW, healthcare workers; HMPV, human metapneumovirus; PIV, parainfluenza viruses; RSV, respiratory syncytial virus.