Management of acute COVID-19 in the pediatric population and role of antimicrobial therapy

SARS-CoV-2 infection is typically less severe in children and adolescents compared to adults and the vast majority of pediatric patients do not require any care or will recover with supportive care only. In the absence of adequate pediatric data, most recommendations for children and adolescents are based on efficacy and safety data from adult studies and the optimal approach to the management of pediatric patients with acute COVID-19 is not yet determined. A number of national pediatric guidelines are available, and these continue to evolve rapidly with the emergence of new study information. As of January 2022 data from clinical trials in adult patients suggested a benefit to mortality outcomes with the use of dexamethasone, tocilizumab, and janus kinase inhibitors in certain subgroups of patients, potential benefit from the use of remdesivir, as well as emerging evidence for COVID-19 specific monoclonal antibody use. Given the paucity of pediatric data, the use of specific therapy in the context of acute COVID-19 is not considered routine, and decisions regarding specific therapy use are made on discussion with the multidisciplinary clinical team including infectious diseases experts. Guidelines recommend where possible children should be enrolled in available clinical trials. On a case-by-case basis, guidelines suggest specific therapy may be considered appropriate in children with severe or critical COVID-19 or in cases of mild and moderate disease where risk factors for progression to the severe disease exist. This chapter provides an overview of available evidence as of January 2022 and guidance on supportive care and the use of specific therapies for the management of both hospitalized and nonhospitalized pediatric patients with acute COVID-19. It should be noted that due to the rapid evolution of evidence, regularly updated local, national and regional guidance documents should be consulted when determining treatment of pediatric patients with acute COVID-19.