Kathleen Chiotos1,2,3, Molly Hayes3, David W Kimberlin4, Sarah B Jones5,6, Scott H James4, Swetha G Pinninti4, April Yarbrough7, Mark J Abzug8, Christine E MacBrayne9, Vijaya L Soma10, Daniel E Dulek11, Surabhi B Vora12, Alpana Waghmare12,13, Joshua Wolf14, Rosemary Olivero15, Steven Grapentine16, Rachel L Wattier17, Laura Bio18, Shane J Cross19, Nicholas O Dillman20, Kevin J Downes2, Kathryn Timberlake21, Jennifer Young22, Rachel C Orscheln23, Pranita D Tamma24, Hayden T Schwenk25, Philip Zachariah26, Margaret Aldrich27, David L Goldman27, Helen E Groves28, Gabriella S Lamb29, Alison C Tribble30, Adam L Hersh31, Emily A Thorell31, Mark R Denison11, Adam J Ratner10,32, Jason G Newland23, Mari M Nakamura6,29. 1. Department of Anesthesia and Critical Care Medicine, Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 2. Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 3. Antimicrobial Stewardship Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 4. Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA. 5. Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, USA. 6. Antimicrobial Stewardship Program, Boston Children's Hospital, Boston, Massachusetts, USA. 7. Department of Pharmacy, Children's of Alabama, Birmingham, Alabama, USA. 8. Department of Pediatrics, Division of Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA. 9. Department of Pharmacy, Children's Hospital Colorado, Aurora, Colorado, USA. 10. Department of Pediatrics, Division of Infectious Diseases, New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, New York, USA. 11. Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University and Monroe Carell Jr. Children's Hospital, Nashville, Tennessee, USA. 12. Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA. 13. Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. 14. Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA. 15. Department of Pediatrics and Human Development, Section of Infectious Diseases, Helen DeVos Children's Hospital of Spectrum Health, Michigan State College of Human Medicine, Grand Rapids, Michigan, USA. 16. Department of Pharmacy, University of California-San Francisco Benioff Children's Hospital, San Francisco, California, USA. 17. Department of Pediatrics, Division of Infectious Diseases and Global Health, University of California-San Francisco, San Francisco, California, USA. 18. Department of Pharmacy, Lucile Packard Children's Hospital Stanford, Stanford, California, USA. 19. Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA. 20. Department of Pharmacy, CS Mott Children's Hospital, Ann Arbor, Michigan, USA. 21. Department of Pharmacy, The Hospital for Sick Children, Toronto, Canada. 22. Department of Pharmacy, St. Louis Children's Hospital, St. Louis, Missouri, USA. 23. Department of Pediatrics, Division of Infectious Diseases, Washington University and St. Louis Children's Hospital, St. Louis, Missouri, USA. 24. Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 25. Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Stanford, California, USA. 26. Department of Pediatrics, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA. 27. Department of Pediatrics, Division of Infectious Diseases, Children's Hospital at Montefiore, New York, New York, USA. 28. Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada. 29. Department of Pediatrics, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA. 30. Department of Pediatrics, Division of Infectious Diseases, University of Michigan and CS Mott Children's Hospital, Ann Arbor, Michigan, USA. 31. Department of Pediatrics, Division of Infectious Diseases, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA. 32. Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA.
Abstract
BACKGROUND: Although coronavirus disease 2019 (COVID-19) is mild in nearly all children, a small proportion of pediatric patients develop severe or critical illness. Guidance is therefore needed regarding use of agents with potential activity against severe acute respiratory syndrome coronavirus 2 in pediatrics. METHODS: 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. RESULTS: 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. CONCLUSIONS: Antiviral therapy for COVID-19 is not necessary for the great majority of pediatric patients. For those rare cases of severe or critical disease, this guidance offers 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.
BACKGROUND: Although coronavirus disease 2019 (COVID-19) is mild in nearly all children, a small proportion of pediatric patients develop severe or critical illness. Guidance is therefore needed regarding use of agents with potential activity against severe acute respiratory syndrome coronavirus 2 in pediatrics. METHODS: 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. RESULTS: 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. CONCLUSIONS: Antiviral therapy for COVID-19 is not necessary for the great majority of pediatric patients. For those rare cases of severe or critical disease, this guidance offers 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.
Authors: Biykem Bozkurt; Sandeep R Das; Daniel Addison; Aakriti Gupta; Hani Jneid; Sadiya S Khan; George Augustine Koromia; Prathit A Kulkarni; Kathleen LaPoint; Eldrin F Lewis; Erin D Michos; Pamela N Peterson; Mohit K Turagam; Tracy Y Wang; Clyde W Yancy Journal: J Am Coll Cardiol Date: 2022-06-23 Impact factor: 27.203
Authors: Julianne E Burns; Cary Thurm; James W Antoon; Carlos G Grijalva; Matt Hall; Adam L Hersh; Gabrielle Z Hester; Emilie Korn; Mario A Reyes; Samir S Shah; Balagangadhar R Totapally; Ronald J Teufel Journal: Pediatrics Date: 2022-09-01 Impact factor: 9.703
Authors: Biykem Bozkurt; Sandeep R Das; Daniel Addison; Aakriti Gupta; Hani Jneid; Sadiya S Khan; George Augustine Koromia; Prathit A Kulkarni; Kathleen LaPoint; Eldrin F Lewis; Erin D Michos; Pamela N Peterson; Mohit K Turagam; Tracy Y Wang; Clyde W Yancy Journal: Circ Cardiovasc Qual Outcomes Date: 2022-06-23
Authors: Arnaud G L'Huillier; Lara Danziger-Isakov; Abanti Chaudhuri; Michael Green; Marian G Michaels; Klara M Posfay-Barbe; Dimitri van der Linden; Anita Verma; Mignon McCulloch; Monica I Ardura Journal: Pediatr Transplant Date: 2021-03-10
Authors: Anthony J Garcia-Prats; Nicole Salazar-Austin; James H Conway; Kendra Radtke; Sylvia M LaCourse; Elizabeth Maleche-Obimbo; Anneke C Hesseling; Rada M Savic; Sharon Nachman Journal: Clin Infect Dis Date: 2021-03-15 Impact factor: 9.079