Multicenter Interim Guidance on Use of Antivirals for Children With Coronavirus Disease 2019/Severe Acute Respiratory Syndrome Coronavirus 2

Abstract

Background Although Coronavirus Disease 2019 (COVID-19) is a mild infection in most children, a small proportion develop severe or critical illness. Data evaluating agents with potential antiviral activity continue to expand, such that updated guidance is needed regarding use of these agents in children. Methods A panel of pediatric infectious diseases physicians and pharmacists from 20 geographically diverse North American institutions was convened. Through a series of teleconferences and web-based surveys, a set of guidance statements was developed and refined based on review of the best available evidence and expert opinion. Results Given the typically mild course of COVID-19 in children, supportive care alone is suggested for most cases. For children with severe illness, defined as a supplemental oxygen requirement without need for non-invasive or invasive mechanical ventilation or extra-corporeal membrane oxygenation (ECMO), remdesivir is suggested, preferably as part of a clinical trial if available. Remdesivir should also be considered for critically ill children requiring invasive or non-invasive mechanical ventilation or ECMO. A duration of 5 days is appropriate for most patients. The panel recommends against the use of hydroxychloroquine or lopinavir-ritonavir (or other protease inhibitors) for COVID-19 in children. Conclusions Antiviral therapy for COVID-19 is not necessary for the great majority of pediatric patients. For children with severe or critical disease, this guidance offers an approach for decision-making regarding use of remdesivir.

Multi-organ damage by covid-19: congestive (cardio-pulmonary) heart failure, and blood-heart barrier leakage

“…Several drugs have recently been either suggested or being clinically administered to relive the symptoms of covid-19. These include dapagliflozin (sodium glucose co-transporter 2; SGLT2 inhibitor; an antidiabetic), Lopinavir/Ritonavir, Darunavir/Umifenovir (anti-HIV), Remdesivir (anti-Ebola), Favipiravir, and Dipyridamole (anti-hypertensive) [ 2 – 13 ]. Also, an anti-acid (Famotidine) is also being promoted [ 14 ].…”

Impact of COVID-19 Pandemic on Pediatrics and Pediatric Transplantation Programs

“…Limited data exist regarding effective treatment strategies for SARS-CoV-2 in pediatric patients. Collaboratives of pediatric providers, the National Institutes of Health (NIH) and the Infectious Diseases Society of America (ISDA) have issued treatment recommendations predominantly extrapolated from adult studies (42)(43)(44). There are currently no FDA approved therapeutic agents for the treatment of COVID-19 in pediatric patients, although both remdesivir and SARS-CoV-2 rich convalescent plasma are available through an emergency use authorization.…”

Pharmacotherapy of Acute COVID-19 Infection and Multisystem Inflammatory Syndrome in Children: Current State of Knowledge

“…15 Due to limited data in children, a panel of pediatric infectious disease specialists published a guidance document on April 22, 2020, on the use of antiviral pharmacotherapies. 1 Given the occurrence of a milder disease in children, the paucity of data, and the potential for toxicity from antiviral agents, the panel determined that the risks of antiviral therapies may outweigh the benefits. Children should, therefore, receive antiviral agents if severe or critically ill and then only as part of a clinical trial.…”

“…S evere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic by the World Health Organization on March 12, 2020 after the outbreak in Wuhan, Hubei Province, China in December 2019. 1 At the time of this publication, SARS-CoV-2 has infected more than 12,500,000 people worldwide and has caused more than 566,000 deaths. 2 Children make up a smaller proportion of patients with acute coronavirus disease 2019 (COVID-19) infection and tend to develop a milder disease than adults.…”

“…3 Rates of morbidity and mortality in children are low compared with adults, except children less than 1 year of age and children with comorbidities tend to require more hospitalizations. 1 Morbidity has been reported in 0.6% to 2% of children, according to reports from Chinese and American children, respectively. Complications include respiratory distress or failure, encephalopathy, cardiac injury or failure, acute kidney injury, septic shock, and/or coagulation abnormalities.…”