Pediatric COVID-19

Key Information

Appropriate treatment of concomitant pneumonia, respiratory failure, ARDS, sepsis, septic shock

Anticoagulation therapy should be risk stratified: see Clinical Management below.

Drug Information

More Information

This guideline will be continually updated as more evidence becomes available. Current as of August 26, 2021.

  1. FDA emergency use authorization for remdesivir. Accessed 2020 July 5. Available Here
  2. Novel Coronavirus Pneumonia Emergency Response Epidemiology. [The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145–151. DOI:10.3760/cma.j.issn.0254-6450.2020.02.003.
  3. Yao X, et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis. 2020 Mar 9. Available Here
  4. Wolkowiez MC, Maharaj A, Wu H, et al. Pediatric Trials Network (PTN) Hydroxychloroquine Pediatric Dosing Guidelines to Target Treatment of SARS-CoV-2 Virus. 2020 Mar 20.
  5. Hydroxychloroquine clinical trial (NCT04261517). Available Here
  6. Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949. Available Here
  7. Multicenter collaboration group of Department of Science and Technology of Guangdong Province and Health Commission of GuangdongProvince for chloroquine in the treatment of novel coronavirus pneumonia. Expert consensus on chloroquine phosphate for thetreatment of novel coronavirus pneumonia Chinese Journal of Tuberculosis and Respiratory Diseases 43, no. 0. Available Here
  8. Wang M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Research. 2020 30;269-71. Available Here
  9. Cortegiana, et al. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care. 2020 Mar Available Here
  10. Summaries of evidence from selected experimental therapeutics, as of October 2018. World Health Organization website. Available Here Updated October 11, 2018. Accessed March 25, 2020Xiaoling X, et al. Effective treatment of Severe COVID-19 Patients with Tocilizumab. [Pre-print – not peer reviewed]. http://chinaxiv.org/abs/202003.00026.
  11. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2020 Mar 20. Identifier NCT04317092, Tocilizumab in COVID19 Pneumonia (TOCIVID19); 2020 Mar 20 [cited 2020 Mar 25]. Available Here Darunavir/cobicistat clinical trial (NCT04252274). https://clinicaltrials.gov/ct2/show/NCT04252274.
  12. Darunavir/cobicistat clinical trial (NCT04252274). Available Here
  13. Arabi YM, et al. Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter Observational Study. Clin Infect Dis. 2019 Jun 25. Available Here
  14. Mo Y, Fisher D. A review of treatment modalities for Middle East Respiratory Syndrome. J Antimicrob Chemother. 2016 Dec;71(12):3340-3350. Available Here
  15. Gamino-Arroyo AE, et al. Efficacy and Safety of Nitazoxanide in Addition to Standard of Care for the Treatment of Severe Acute Respiratory Illness. Clin Infect Dis. 2019 Dec 69;11:1903-11. Available Here
  16. Gross AE, Bryson ML. Oral Ribavirin for the Treatment of Noninfluenza Respiratory Viral Infections: A Systematic Review. Ann Pharmacother. 2015 Oct;49(10):1125-35. Available Here
  17. Arabi YM, et al. Ribavirin and Interferon Therapy for Critically Ill Patients With Middle East Respiratory Syndrome: A Multicenter Observational Study. Clin Infect Dis. 2019 Jun 25. Available Here
  18. WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. Accessed 2020 Mar 12. Available Here
  19. CDC. Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). Accessed 2020 Mar 12. Available Here
  20. Cao B, Wang Y, Wen D, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N Engl J Med. DOI: 10.1056/NEJMoa2001282. Available Here
  21. FDA. FDA advises patients on use of Non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19. Accessed 2020 Mar 26. Available Here
  22. NephJC (nephrology online journal club) detailed review with links to society statements. Accessed 2020 Mar 16. Available Here
  23. Borba M, Val F, et al. Chloroquine diphosphate in two different dosage as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study). Accessed 2020 Apr 16. Available Here
  24. Magagnoli J, Narendran, S, et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. BMJ 2020 Apr 16. Available Here
  25. Villar J, Ferrando C, Martinez D, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med 2020; 8(3): 267-76.
  26. Horby P, Lim WS, Emberson J, et al. Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report. medRxiv 2020: 2020.06.22.20137273.
  27. Corral L, Bahamonde A, Arnaiz delas Revillas F, et al. GLUCOCOVID: A controlled trial of methylprednisolone in adults hospitalized with COVID-19 pneumonia. medRxiv 2020: 2020.06.17.20133579.
  28. Salton F, Confalonieri P, Santus P, et al. Prolonged low-dose methylprednisolone in patients with severe COVID-19 pneumonia. medRxiv 2020: 2020.06.17.20134031.
  29. Wang Y, Jiang W, He Q, et al. Early, low-dose and short-term application of corticosteroid treatment in patients with severe COVID-19 pneumonia: single-center experience from Wuhan, China. medRxiv 2020: 2020.03.06.20032342)
  30. Bhimrah A, Morgan R, Hirsch Chumaker A, et al. Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID-19. Clin Infect Dis. 2020 Apr 27;ciaa478. doi: 10.1093/cid/ciaa478. Accessed July 5, 2020
  31. Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020;145:1-10
  32. Mitchell WB, Davila J, Keenan J, et al. Children and young adults hospitalized for severe COVID-19 exhibit thrombotic coagulopathy. Pediatr Blood Cancer. 2021;68:e28975
  33. Goldenberg NA, Sochet A, Albisetti M, et al; the Pediatric/Neonatal Hemostasis and Thrombosis Subcommittee of the ISTH SSC. Consensus-baed clinical recommendations and research priorities for anticoagulant thromboprophylaxis in children hospitalized for COVID-19-related illness. J Thromb Haemost. 2020;18:3099-3105
  34. Libster R, Marc GP, Wappner D, et al. INFANT-COVID-19 Group. Early High-Titer Plasma Therapy to Prevent Severe Covid-19 in Older Adults. N Engl J Med. 2021;384:610-8
  35. The RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with COVID-19. N Engl J Med. 2021;384:693-704
  36. Tomazini BM, Maia IS, Cavalcanti AB, et al. Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial. JAMA. 2020;324:1307-1316
  37. Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020;174(9):868-873
  38. Kotch C, Barrett D, Teachey DT. Tocilizumab for the treatment of chimeric antigen receptor T cell-induced cytokine release syndrome. Expert Rev Clin Immunol. 2019;15(8):813-822
  39. Derespina KR, Kaushik S, Plichta A, et al. Clinical manifestations and outcomes of critically ill children and adolescents with coronavirus disease 2019 in New York City. J Pediatr. 2020;Published online ahead of print.
  40. Guidance for Treatment of COVID-19 in Adults and Children. University of Michigan. Revised 1/27/21
  41. Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatr Pulmonol. 2020;55:1169-1174
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