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

Journal of the Pediatric Infectious Diseases Society - Tập 10 Số 1 - Trang 34-48 - 2021
Kathleen Chiotos1,2,3, Molly Hayes1, David W. Kimberlin4, Sarah Bruyn Jones5,6, Scott H. James4, Swetha Pinninti4, April Yarbrough7, Mark J. Abzug8, Taiju Miyagami9, Vijaya L. Soma10, Daniel E. Dulek11, Surabhi B Vora12, Alpana Waghmare12,13, Joshua Wolf14, Rosemary Olivero15, Steven P Grapentine16, Rachel L Wattier17, Laura L. Bio18, Shane J. Cross19, Nicholas O. Dillman20, Kevin J. Downes3, Carlos R. Oliveira21, Kathryn Timberlake22, Jennifer L. Young23, Rachel C. Orscheln24, Pranita D. Tamma25, Hayden T. Schwenk26, Philip Zachariah27, Margaret Aldrich28, David L. Goldman28, Helen Groves29, Nipunie Rajapakse30, Gabriella S Lamb31, Alison C. Tribble32, Adam L. Hersh33, Emily A. Thorell33, Mark R. Denison11, Adam J. Ratner34,10, Jason G. Newland24, Mari Nakamura5,31
1Antimicrobial Stewardship Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
2Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
3Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
4Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
5Antimicrobial Stewardship Program, Boston Children's Hospital, Boston, Massachusetts, USA
6Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, USA
7Department of Pharmacy, Children's of Alabama, Birmingham, Alabama, USA
8Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
9Department of Pharmacy, Children's Hospital Colorado, Aurora, Colorado, USA
10Division of Infectious Diseases, Department of Pediatrics, New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, New York, USA
11Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University and Monroe Carell Jr. Children's Hospital, Nashville, Tennessee, USA
12Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
13Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
14Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee, USA
15Section 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
16Department of Pharmacy, University of California–San Francisco Benioff Children’s Hospital, San Francisco, California, USA
17Division of Infectious Diseases and Global Health, Department of Pediatrics, University of California–San Francisco, San Francisco, California, USA
18Department of Pharmacy, Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
19Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
20Department of Pharmacy, CS Mott Children's Hospital, Ann Arbor, Michigan, USA
21Yale University School of Medicine, Yale University, New Haven, Connecticut, USA
22Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
23Department of Pharmacy, St. Louis Children's Hospital, St. Louis, Missouri, USA
24Division of Infectious Diseases, Department of Pediatrics, Washington University and St. Louis Children's Hospital, St. Louis, Missouri, USA
25Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
26Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford, Stanford, California, USA
27Division of Infectious Diseases, Department of Pediatrics, Columbia University, New York, New York, USA
28Division of Infectious Diseases, Department of Pediatrics, Children's Hospital at Montefiore, New York, New York, USA
29Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
30Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
31Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
32Department of Pediatrics, Division of Infectious Diseases, University of Michigan and CS Mott Children's Hospital, Ann Arbor, Michigan, USA
33Division of Infectious Diseases, Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, Utah, USA
34Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA

Tóm tắt

AbstractBackgroundAlthough 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.MethodsA 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.ResultsGiven 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.ConclusionsAntiviral 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.

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Journal of the Pediatric Infectious Diseases Society

Tập 10 Số 1

34-48

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