7. Which groups of medication are thought to be potentially effective for COVID-19 treatment in the pediatric age group?

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7. Which groups of medication are thought to be potentially effective for COVID-19 treatment in the pediatric age group?

There is a lack of data supporting efficacy of antiviral agents for the treatment of COVID-19 in children, however there are available recommendations from multicenter initial guidance on the use of antiviral agents in children. [37,38] Given the typically mild course of pediatric COVID-19, supportive care alone is suggested for the overwhelming majority of cases. Antiviral therapy generally should be reserved only for symptomatic children or those with underlying conditions related with higher risk of disease progression.

Antiviral drugs:

Remdesivir inhibits RNA-dependent RNA polymerase and has activity against coronaviruses. According to multicenter panel Remdesivir is preferred to other agents due to it’s proven better tolerance and beneficial effects compared with other antiviral agents in adult population with COVID-19. Hence the same assumption is being made for children, even though data regarding the benefits of remdesivir for children with COVID-19 are lacking.

Lopinavir / Ritonavir is not recommended for children due to the absence of efficacy and unfavorable pharmacodynamics and negative clinical trial data. [39]

Antimalarials agents:

Hydroxychloroquine is being investigated as a treatment for COVID-19 in clinical trials, although not licensed for this indication. It can cause conduction disorders especially QT prolongation. QT should be monitored closely. especially in the setting of LQTS with COVID-19. [15,40]

Combination of hydroxychloroquine plus azithromycin is not recommended because of the potential for toxicities. [41] Both drugs cause prolongation of the Q-T interval and are synergistic in this effect, increasing the risk of severe arrhythmia. This combination of drugs should be avoided in particular in patients with Long Q-T syndrome, and in all congenital heart patients with a Q-T prolongation in association to the anatomical malformation.

Immune modulators for adjunctive therapy:

The benefits and risks of immune modulators (eg, glucocorticoids, IL-6 inhibitors, interferon-beta 1b) and of convalescent plasma from recovered COVID-19 patients in the treatment of children with COVID-19 are uncertain. The use of these medication are referred only on a case-by-case basis according to disease severity. The routine use for COVID-19 patients is not recommended. The cytokine profiles of serum from some patients with moderate to severe COVID-19 overlap with those seen in macrophage activation syndrome and secondary hemophagocytic lymphohistiocytosis thus IL-6 and IL-1 blockades and Janus kinase (JAK) inhibition, has been proposed as an approach to treat the systemic inflammation associated with severe COVID-19 illness. [42] Corticosteroids are reserved only for critically ill patients with COVID-19. There is insufficient evidence for or against systemic corticosteroids for mechanically ventilated patients with ARDS (CI), and for adults with COVID-19 and refractory shock, the NIH recommends using low-dose corticosteroid therapy (BII). [41]

There is no available data on the use of vitamin A for COVID-19, however it is recommended to be used as adjunctive agent for COVID-19 patients due to its effect on decreased morbidity and mortality from measles-associated pneumonia. [43]

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