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The Therapy of SARS-CoV-2 Infection in Children
1Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
Insights
This review synthesizes expert guidelines for treating pediatric SARS-CoV-2 (COVID-19) infections. It covers early antiviral therapies and later immune dysregulation treatments, including for multisystem inflammatory syndrome in children (MIS-C).
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Clinical Therapeutics
Background:
- SARS-CoV-2 (COVID-19) impact on children is generally less severe than in adults, but high-risk groups face severe outcomes.
- Limited pediatric clinical trials necessitate extrapolating adult data for treatment efficacy in children.
- Expert consensus guidelines were developed by NIH, IDSA, and PIDS to address pediatric COVID-19 therapy.
Purpose of the Study:
- To synthesize comprehensive recommendations for the therapeutic management of SARS-CoV-2 infections in children.
- To provide guidance on treating both the early infectious period and later immune dysregulation in pediatric COVID-19.
- To outline the therapeutic approach for multisystem inflammatory syndrome in children (MIS-C).
Main Methods:
- Review and synthesis of expert consensus guidelines from national health and infectious disease societies.
- Analysis of therapeutic strategies for early SARS-CoV-2 infection and later immune complications.
- Inclusion of treatment protocols for antiviral agents, corticosteroids, and immunomodulators.
Main Results:
- Recommendations cover early-phase antiviral treatment with agents like remdesivir and nirmatrelvir/ritonavir.
- Guidance addresses late-phase immune dysregulation using corticosteroids and immunomodulators.
- Specific therapeutic approaches for multisystem inflammatory syndrome in children (MIS-C) are detailed.
Conclusions:
- Comprehensive guidelines exist for pediatric SARS-CoV-2 therapy, addressing various disease stages and complications.
- Therapeutic strategies leverage both antiviral and immunomodulatory approaches based on expert consensus.
- Management of MIS-C is a critical component of pediatric COVID-19 treatment recommendations.
Abstract:
The impact of SARS-CoV-2 infections in children has fortunately been lower than what has been seen in adults. However, even previously healthy children have developed severe disease, sometimes with subsequent mortality, and those who are infants or adolescents, are from racial and ethnic minority groups, or have certain chronic conditions are at higher risk of these outcomes. During the pandemic, extensive studies of therapeutic agents, including antivirals and immunomodulators, were conducted in adults. Few trials included children, and most were in older children and adolescents. Thus, the potential benefits of therapies in children must be extrapolated from adult evidence. Despite these limitations, advisory committees of the National Institute of Health (NIH), the Infectious Disease Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) were constituted, and expert consensus guidelines were developed. This review provides a synthesis of those comprehensive recommendations for therapy in children. These address treatment during the early infectious period with antiviral agents, including remdesivir and nirmatrelvir/ritonavir, as well as treatment in the later period of immune dysregulation with corticosteroids and immunomodulators. In addition, the therapeutic approach for multisystem inflammatory syndrome in children (MIS-C), also referred to as Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), is also provided.
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