Multicenter Initial Guidance on Use of Antivirals for Children With Coronavirus Disease 2019/Severe Acute Respiratory Syndrome Coronavirus 2
Open Access
- 22 April 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of the Pediatric Infectious Diseases Society
- Vol. 9 (6), 701-715
- https://doi.org/10.1093/jpids/piaa045
Abstract
Although Coronavirus Disease 2019 (COVID-19) is mild in nearly all children, a small proportion of pediatric patients develops severe or critical illness. Guidance is therefore needed regarding use of agents with potential activity against severe acute respiratory syndrome coronavirus 2 in pediatrics. A panel of pediatric infectious diseases physicians and pharmacists from 18 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 best available evidence and expert opinion. Given the typically mild course of pediatric COVID-19, supportive care alone is suggested for the overwhelming majority of cases. The panel suggests a decision-making framework for antiviral therapy that weighs risks and benefits based on disease severity as indicated by respiratory support needs, with consideration on a case-by-case basis of potential pediatric risk factors for disease progression. If an antiviral is used, the panel suggests remdesivir as the preferred agent. Hydroxychloroquine could be considered for patients who are not candidates for remdesivir or when remdesivir is not available. Antivirals should preferably be used as part of a clinical trial if available. Antiviral therapy for COVID-19 is not necessary for the great majority of pediatric patients. For those rare children who develop severe or critical disease, this guidance offer an approach for decision-making regarding antivirals, informed by available data. As evidence continues to evolve rapidly, the need for updates to the guidance is anticipated.Keywords
Funding Information
- Agency for Healthcare Research and Quality (K12-HS026393)
This publication has 90 references indexed in Scilit:
- Coronaviruses Lacking Exoribonuclease Activity Are Susceptible to Lethal Mutagenesis: Evidence for Proofreading and Potential TherapeuticsPLoS Pathogens, 2013
- Nevirapine versus Ritonavir-Boosted Lopinavir for HIV-Infected ChildrenThe New England Journal of Medicine, 2012
- Fatality rates in published reports of RSV hospitalizations among high-risk and otherwise healthy childrenCurrent Medical Research and Opinion, 2010
- The Burden of Respiratory Syncytial Virus Infection in Young ChildrenThe New England Journal of Medicine, 2009
- Molecular dynamic simulations analysis of ritronavir and lopinavir as SARS-CoV 3CLpro inhibitorsJournal of Theoretical Biology, 2008
- Sleep-disordered breathing in overweight and obese children and adolescents: prevalence, characteristics and the role of fat distributionArchives of Disease in Childhood, 2007
- In vitro susceptibility of 10 clinical isolates of SARS coronavirus to selected antiviral compoundsJournal of Clinical Virology, 2004
- HIV protease inhibitor nelfinavir inhibits replication of SARS-associated coronavirusBiochemical and Biophysical Research Communications, 2004
- Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findingsThorax, 2004
- Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of admission and management variation in patients hospitalized with respiratory syncytial viral lower respiratory tract infectionThe Journal of Pediatrics, 1996