tetano
Editor, Senior Moderator
J Pediatric Infect Dis Soc
. 2020 Sep 12;piaa115.
doi: 10.1093/jpids/piaa115. Online ahead of print.
Multicenter interim guidance on use of antivirals for children with COVID-19/SARS-CoV-2
Kathleen Chiotos[SUP] 1 2 3 [/SUP], Molly Hayes[SUP] 3 [/SUP], David W Kimberlin[SUP] 4 [/SUP], Sarah B Jones[SUP] 5 6 [/SUP], Scott H James[SUP] 4 [/SUP], Swetha G Pinninti[SUP] 4 [/SUP], April Yarbrough[SUP] 7 [/SUP], Mark J Abzug[SUP] 8 [/SUP], Christine E MacBrayne[SUP] 9 [/SUP], Vijaya L Soma[SUP] 10 [/SUP], Daniel E Dulek[SUP] 11 [/SUP], Surabhi B Vora[SUP] 12 [/SUP], Alpana Waghmare[SUP] 12 13 [/SUP], Joshua Wolf[SUP] 14 [/SUP], Rosemary Olivero[SUP] 15 [/SUP], Steven Grapentine[SUP] 16 [/SUP], Rachel L Wattier[SUP] 17 [/SUP], Laura Bio[SUP] 18 [/SUP], Shane J Cross[SUP] 19 [/SUP], Nicholas O Dillman[SUP] 20 [/SUP], Kevin J Downes[SUP] 2 [/SUP], Carlos R Oliveira[SUP] 21 [/SUP], Kathryn Timberlake[SUP] 22 [/SUP], Jennifer Young[SUP] 23 [/SUP], Rachel C Orscheln[SUP] 24 [/SUP], Pranita D Tamma[SUP] 25 [/SUP], Hayden T Schwenk[SUP] 26 [/SUP], Philip Zachariah[SUP] 27 [/SUP], Margaret L Aldrich[SUP] 28 [/SUP], David L Goldman[SUP] 28 [/SUP], Helen E Groves[SUP] 29 [/SUP], Nipunie S Rajapakse[SUP] 30 [/SUP], Gabriella S Lamb[SUP] 31 [/SUP], Alison C Tribble[SUP] 32 [/SUP], Adam L Hersh[SUP] 33 [/SUP], Emily A Thorell[SUP] 33 [/SUP], Mark R Denison[SUP] 11 [/SUP], Adam J Ratner[SUP] 10 34 [/SUP], Jason G Newland[SUP] 24 [/SUP], Mari M Nakamura[SUP] 6 31 [/SUP]
Affiliations
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.
Keywords: COVID-19; SARS-CoV-2; antiviral; pediatric.
. 2020 Sep 12;piaa115.
doi: 10.1093/jpids/piaa115. Online ahead of print.
Multicenter interim guidance on use of antivirals for children with COVID-19/SARS-CoV-2
Kathleen Chiotos[SUP] 1 2 3 [/SUP], Molly Hayes[SUP] 3 [/SUP], David W Kimberlin[SUP] 4 [/SUP], Sarah B Jones[SUP] 5 6 [/SUP], Scott H James[SUP] 4 [/SUP], Swetha G Pinninti[SUP] 4 [/SUP], April Yarbrough[SUP] 7 [/SUP], Mark J Abzug[SUP] 8 [/SUP], Christine E MacBrayne[SUP] 9 [/SUP], Vijaya L Soma[SUP] 10 [/SUP], Daniel E Dulek[SUP] 11 [/SUP], Surabhi B Vora[SUP] 12 [/SUP], Alpana Waghmare[SUP] 12 13 [/SUP], Joshua Wolf[SUP] 14 [/SUP], Rosemary Olivero[SUP] 15 [/SUP], Steven Grapentine[SUP] 16 [/SUP], Rachel L Wattier[SUP] 17 [/SUP], Laura Bio[SUP] 18 [/SUP], Shane J Cross[SUP] 19 [/SUP], Nicholas O Dillman[SUP] 20 [/SUP], Kevin J Downes[SUP] 2 [/SUP], Carlos R Oliveira[SUP] 21 [/SUP], Kathryn Timberlake[SUP] 22 [/SUP], Jennifer Young[SUP] 23 [/SUP], Rachel C Orscheln[SUP] 24 [/SUP], Pranita D Tamma[SUP] 25 [/SUP], Hayden T Schwenk[SUP] 26 [/SUP], Philip Zachariah[SUP] 27 [/SUP], Margaret L Aldrich[SUP] 28 [/SUP], David L Goldman[SUP] 28 [/SUP], Helen E Groves[SUP] 29 [/SUP], Nipunie S Rajapakse[SUP] 30 [/SUP], Gabriella S Lamb[SUP] 31 [/SUP], Alison C Tribble[SUP] 32 [/SUP], Adam L Hersh[SUP] 33 [/SUP], Emily A Thorell[SUP] 33 [/SUP], Mark R Denison[SUP] 11 [/SUP], Adam J Ratner[SUP] 10 34 [/SUP], Jason G Newland[SUP] 24 [/SUP], Mari M Nakamura[SUP] 6 31 [/SUP]
Affiliations
- PMID: 32918548
- DOI: 10.1093/jpids/piaa115
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.
Keywords: COVID-19; SARS-CoV-2; antiviral; pediatric.