Paediatric
Treatment of symptomatic hospital onset COVID-19
All cases need to be discussed with paediatric ID team.
Consider treating under the following conditions:
- Hospitalised for indications other than for the management of acute symptoms of COVID-19, AND
- Onset of symptoms of COVID-19 within the last 7 days (for remdesivir), remains symptomatic and with no signs of clinical recovery, AND
- SARS-CoV-2 infection is confirmed by either PCR or lateral flow test, AND
- The patient is a member of the 'highest' risk group (as defined in the Department of Health and Social Care commissioned Independent Advisory Group report) OR COVID-19 infection presents a material risk of destabilising a pre-existing condition or compromising recovery from a procedure (as determined by MDT assessment), AND
- The patient is NOT requiring new supplementary oxygen specifically for the management of COVID-19 symptoms
Refer to the Treatment of COVID-19 in patients hospitalised due to COVID-19 for patients who deteriorate and require hospital-based care and/or supplemental oxygen for the management of COVID-19 symptoms.
Preferred: Remdesivir
Remdesivir
Inclusion criteria:
- paediatric patients weighing at least 40 kgs
AND
- symptom onset within 7 days.
Exclusion criteria:
- ALT 5 times or more the upper limit of normal
- eGFR less than 30ml/min (except in patients with end-stage renal disease on haemodialysis)
- Paediatric patients weighing less than 40kgs
- Require hospital-level care for the management of acute COVID-19 illness
- New supplemental oxygen requirement specifically for the management of COVID-19 symptoms
- Known hypersensitivity reaction to the active substances or to any of the excipients in the Summary of Product Characteristics for remdesivir
Dosing:
Patients at least 40 kg:
Day 1: 200mg remdesivir as a single dose iv
Day 2 onwards: 100mg remdesivir iv OD for 2 days
Total duration of treatment is 3 days.
Remdesivir should be discontinued in patients who develop any of the following:
- ALT 5 times or more the upper limit of normal during treatment with remdesivir (remdesivir may be restarted when ALT is less than 5 times the upper limit of normal)
- ALT elevation accompanied by signs or symptoms of liver inflammation or increasing conjugated bilirubin, alkaline phosphatase, or international normalised ratio (INR).
Alternative
Speak to Paediatric ID