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, Carlos R Oliveira21, Kathryn Timberlake22, Jennifer Young23, Rachel C Orscheln24, Pranita D Tamma25, Hayden T Schwenk26, Philip Zachariah27, Margaret L Aldrich28, David L Goldman28, Helen E Groves29, Nipunie S Rajapakse30, Gabriella S Lamb31, Alison C Tribble32, Adam L Hersh33, Emily A Thorell33, Mark R Denison11, Adam J Ratner10,34, Jason G Newland24, Mari M Nakamura6,31. 1. Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 2. Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 3. Antimicrobial Stewardship Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. 4. Division of Pediatric Infectious Diseases, Department of Pediatrics, 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. Division of Infectious Diseases, Department of Pediatrics, 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. Division of Infectious Diseases, Department of Pediatrics, New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, New York, USA. 11. Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University and Monroe Carell Jr. Children's Hospital, Nashville, Tennessee, USA. 12. Division of Pediatric Infectious Diseases, Department of Pediatrics, 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. Section of Infectious Diseases, Department of Pediatrics and Human Development, 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. Division of Infectious Diseases and Global Health, Department of Pediatrics, University of California-San Francisco, San Francisco, California, USA. 18. Department of Pharmacy, Lucile Packard Children's Hospital Stanford, Palo Alto, 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. Yale University School of Medicine, Yale University, New Haven, Connecticut, USA. 22. Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada. 23. Department of Pharmacy, St. Louis Children's Hospital, St. Louis, Missouri, USA. 24. Division of Infectious Diseases, Department of Pediatrics, Washington University and St. Louis Children's Hospital, St. Louis, Missouri, USA. 25. Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 26. Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Stanford, California, USA. 27. Division of Infectious Diseases, Department of Pediatrics, Columbia University, New York, New York, USA. 28. Division of Infectious Diseases, Department of Pediatrics, Children's Hospital at Montefiore, New York, New York, USA. 29. Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada. 30. Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA. 31. Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA. 32. Department of Pediatrics, Division of Infectious Diseases, University of Michigan and CS Mott Children's Hospital, Ann Arbor, Michigan, USA. 33. Division of Infectious Diseases, Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA. 34. Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA.
Abstract
BACKGROUND: Although coronavirus disease 2019 (COVID-19) is a mild infection in most children, a small proportion develop severe or critical illness. Data describing 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 noninvasive or invasive mechanical ventilation or extracorporeal 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 noninvasive 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.
BACKGROUND: Although coronavirus disease 2019 (COVID-19) is a mild infection in most children, a small proportion develop severe or critical illness. Data describing 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 noninvasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO), remdesivir is suggested, preferably as part of a clinical trial if available. Remdesivir should also be considered for critically illchildren requiring invasive or noninvasive 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.
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: Teresa B Kortz; Emilia Connolly; C Lee Cohen; Rebecca E Cook; Jennifer A Jonas; Michael S Lipnick; Niranjan Kissoon Journal: Pediatr Emerg Care Date: 2021-10-01 Impact factor: 1.602
Authors: Hyunju Lee; Sujin Choi; Ji Young Park; Dae Sun Jo; Ui Yoon Choi; Heayon Lee; Yun Tae Jung; In Hyuk Chung; Young June Choe; Jin Yong Kim; Young-Joon Park; Eun Hwa Choi Journal: J Korean Med Sci Date: 2022-01-03 Impact factor: 2.153