Critical COVID

Critical COVID

Recommended Treatment

Dexamethasone: 0.15mg/kg/dose PO or IV (Max 6 mg/dose) once daily for up to 10 days or until discharge from hospital, if sooner.


For patients on dexamethasone, AND within 14 days of new COVID-19 diagnosis with evidence of cytokine release syndrome/HLH. 

  • For children ≥30 Kg: 8 mg/kg/dose IV once (Max 800 mg/dose) 
  • For children <30 Kg: 12 mg/kg/dose IV once  

On a case-by-case basis where there is evidence of worsening disease such as, increasing oxygen or ventilator requirement and/or evidence of systemic inflammation (e.g. elevated CRP), immunomodulatory agents such as tocilizumab and anakinra may be considered under expert guidance from specialist teams

Management considerations for CRS/secondary HLH and related inflammatory clinical entities secondary to COVID-19:

  • For older children, aged 12 to 18 years, who have confirmed COVID-19 with severe or critical disease requiring intensive care setting management and are receiving optimal dexamethasone therapy, tocilizumab* may be considered on a case-by-case basis
  • Unlikely to be beneficial in mechanically ventilated patients, but may be considered on a case-by-case basis if early in the disease course. 
  • See Remdesivir usage guidelines for dosing.
  • Consider antibiotic therapy if concern for secondary bacterial pneumonia
  • Other potential causes of pneumonia, such as non-SARS-COV-2 respiratory viruses, Streptococcus pneumoniae, Staphylococcus aureus and other bacterial pathogens should be considered in all children admitted with suspected COVID-19.
  • Common organisms implicated in secondary bacterial pneumonia for influenza include; Streptococcus pneumoniae, Staphylococcus aureus, and non-typable Haemophilus influenzae.