Centre issues guidelines for COVID-19 management in kids; usage of Remdesivir not advised

The Centre has come out with comprehensive guidelines for the management of COVID-19 cases among children, however, Remdesivir has not been recommended. In addition, rational use of HRCT imaging has been suggested. The guidelines that were 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 DGHS has recommended that steroid should only be used 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.

Moreover, Remdesivir - the emergency use authorization drug is not recommended in children. The guidelines have cited lack of data regarding safety and efficacy of Remdesivir in children below 18 years of age. The guidelines further suggested rational use of High-resolution CT (HRCT) for seeing the extent and nature of lung involvement in patients with COVID-19.

"There is lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age," the guidelines said.

"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.

The physicians have been recommended to be highly selective in ordering HRCT imaging of the chest in COVID-19 patients. The guidelines further stated that COVID-19 is a viral infection and that antimicrobials have no role in the prevention or treatment of uncomplicated COVID-19 infection. Therefore, 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, the guidelines added. It also added that hospital admission increases the risk of healthcare-associated infections with multidrug-resistant organisms.

The guidelines have stated that for asymptomatic infection among children, no specific medication are required and instead promoted COVID-appropriate behaviour (mask, strict hand hygiene, physical distancing) and suggested giving nutritious diet. In cases of mild infections, paracetamol of 10-15mg/kg/dose may be given every 4-6 hours for fever and throat soothing agents and warm saline gargles in older children and adolescents have been recommended for cough, as per the guidelines. However, in cases of moderate infection, the guidelines suggested initiating immediate oxygen therapy. Necessary management has been advised for severe COVID-19 among children in cases where Acute Respiratory Distress Syndrome (ARDS) develops

"Corticosteroids are not required in all children with moderate illness; they may be administered in rapidly progressive disease and anticoagulants may also be indicated," the guidelines said.

"In case shock develops, necessary management should be initiated. Antimicrobials to be administered if there is evidence/strong suspicion of superadded bacterial infection.  May need organ support in case of organ dysfunction, e.g. renal replacement therapy," it said.

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. 

(With PTI Inputs)