Centre issues COVID management guidelines for children: No remdesivir, no self-medication of steroids

The Centre has come out with comprehensive guidelines for the management of COVID-19 among children in which remdesivir has not been recommended and rational use of HRCT imaging has been suggested. The guidelines issued by the Directorate General of Health Services (DGHS) under the health ministry also said that steroids are harmful in asymptomatic and mild cases of infection. The guidelines also said remdesivir (an emergency use authorisation drug) is not recommended in children. “There is lack of sufficient safety and efficacy data with respect to remdesivir in children below 18 years of age,” the guidelines said. The DGHS recommended steroids only in hospitalised moderately severe and critically ill COVID-19 cases under strict supervision. “Steroids should be used at the right time, in the right dose and for the right duration. Self-medication of steroids must be avoided,” it said. The guidelines suggested rational use of High-resolution CT (HRCT) for seeing the extent and nature of lung involvement in patients with COVID-19. “However, any additional information gained from HRCT scan of the chest often has little impact on treatment decisions, which are based almost entirely on clinical severity and physiological impairment. “Therefore, treating physicians should be highly selective in ordering HRCT imaging of the chest in COVID-19 patients,” the guidelines said. The new COVID-19 management guidelines for children recommend a specific treatment plan in cases of mild, moderate and severe infections: What are the treatment guidelines in case of mild infection?

1. Steroids are harmful in asymptomatic & mild cases of infection and antimicrobials are not recommended for therapy or prophylaxis.
2. Rational use of HRCT imaging has been recommended.
3. For mild infection paracetamol 10-15 mg/kg/dose can be given every 4 to 6 hours for fever and throat soothing agents.
4. Warm saline gargles in older children and adolescents have been recommended for cough.

What are the treatment guidelines in case of moderate infection?

1. In case of moderate infection, guidelines suggest initiating immediate oxygen therapy.
2. Corticosteroids are not required in all children with moderate illness; they may be administered in rapidly progressive disease and anticoagulants may also be indicated.

What are the treatment guidelines in case of severe infection?

1. According to the guidelines, if Acute Respiratory Distress Syndrome (ARDS) develops in a child, necessary management should be initiated. Necessary management should be initiated in case the patient develops shock.
2. The treatment plan recommends antimicrobials if there is evidence/strong suspicion of superadded bacterial infection.
3. Child may need organ support in case of organ dysfunction.
4. A six-minute walk test is recommended for children above 12 years under the supervision of parents/guardians to assess cardiopulmonary exercise tolerance and is used to unmask hypoxia.

Usage of antimicrobials during COVID-19 treatment The guidelines said COVID-19 is a viral infection, and antimicrobials have no role in the prevention or treatment of uncomplicated COVID-19 infection. For asymptomatic and mild cases, the guidelines said antimicrobials are not recommended for therapy or prophylaxis while for moderate and severe cases antimicrobials should not be prescribed unless there is clinical suspicion of a superadded infection. Avoid hospitalisation for asymptomatic children The new guidelines said that hospital admission increases the risk of healthcare-associated infections with multidrug-resistant organisms. For asymptomatic infection among children, the guidelines recommended no specific medication and promoted COVID-appropriate behaviour such as mask, strict hand hygiene, physical distancing, and suggested giving nutritious diet to the patient. How to perform walk test The guidelines also recommended a six-minute walk test for children above 12 years under the supervision of parents/guardians. “It is a simple clinical test to assess cardiopulmonary exercise tolerance and is used to unmask hypoxia. Attach a pulse oximeter to his/her finger and ask the child to walk in the confines of their room for six minutes continuously,” it said.