Table 1

Medications used in the treatment for viral pneumonia

MedicationUsesSpecial consideration
OseltamivirInfluenza pneumonia and uncomplicated influenza infectionOral 75 mg twice daily for 5 days
*Consider longer duration for critically ill patients
Needs dose adjustment for renal impairment, CrCl<50
PeramivirUncomplicated influenza infectionIntravenous 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
ZanamivirUncomplicated 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
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 immunoglobulinHemolytic 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 resolveNephrotoxicity 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
AcyclovirVaricella pneumonitisIntravenous 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 pneumonitisIntravenous 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.