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Medications and Adherence to Treatment Guidelines Among Children Hospitalized With Acute COVID-19

Julianne E Burns1,2, Cary Thurm3, James W Antoon4

  • 1Department of Pediatrics, Division of Hospital Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Pediatrics
|June 15, 2022
PubMed

Insights

COVID-19 medication use in hospitalized children changed after December 2020 guidelines. Steroid and remdesivir use increased, but uptake was incomplete for severe and critical cases, highlighting the need for better adherence to treatment protocols.

Area of Science:

  • Pediatric Infectious Diseases
  • Pharmacology and Therapeutics
  • Epidemiology

Background:

  • COVID-19 treatment guidelines evolved rapidly during the pandemic.
  • The December 2020 IDSA guideline recommended steroids for critical and severe COVID-19.
  • Pediatric Infectious Diseases Society endorsed the guideline.

Purpose of the Study:

  • To evaluate changes in medication use for children hospitalized with COVID-19 after the IDSA guideline publication.
  • To assess adherence to recommended COVID-19 therapies in pediatric patients.

Main Methods:

  • Multicenter, retrospective cohort study of children (30 days to <18 years) hospitalized with acute COVID-19.
  • Compared medication use before and after the December 2020 IDSA guideline (April 2020-December 2021).
  • Stratified analysis by disease severity (mild-moderate, severe, critical) using interrupted time series.

Main Results:

  • Remdesivir and steroid use increased post-guideline, but the trend slowed.
  • In severe disease, 75.4% received steroids and 55.2% remdesivir; in critical disease, 82.4% received steroids and 41.4% remdesivir.
  • Antibiotic use remained high (51.7% severe, 81% critical); tocilizumab use increased, while hydroxychloroquine and azithromycin use decreased.

Conclusions:

  • COVID-19 medication utilization shifted post-guideline, but uptake and adherence were incomplete for severe and critical pediatric cases.
  • Efforts are needed to improve the delivery of guideline-directed therapies to hospitalized children with COVID-19.
  • Further assessment of the effectiveness of these therapies in pediatric populations is warranted.
Abstract

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