No Remdesivir at all: Centre revises COVID treatment guidelines for children

Remdesivir has not been recommended, and a rational use of HRCT (high-resolution computed tomography) imaging has been suggested in the comprehensive government guidelines for COVID management among children.

The guidelines issued by the Directorate General of Health Services (DGHS), under the Union Health Ministry, say that steroids are harmful in asymptomatic and mild infections. The DGHS has recommended steroids only in hospitalised, moderately severe and critically ill COVID 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.

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The guidelines also said Remdesivir (an emergency use authorisation drug) is not recommended in children. “There is a lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age,” the guidelines said.

The guidelines suggested rational use of HRCT for seeing the extent and nature of lung involvement in patients. “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, physicians should be highly selective in ordering HRCT imaging of the chest in COVID-19 patients,” the guidelines said.

They further said COVID is a viral infection, and antimicrobials have no role in the prevention or treatment of an uncomplicated infection.

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For asymptomatic and mild cases, the guidelines, said antimicrobials are not recommended for therapy or prophylaxis. For moderate and severe cases, antimicrobials should not be prescribed unless there is clinical suspicion of a superadded infection.

Hospital admission increases the risk of healthcare-associated infections with multidrug-resistant organisms.

Asymptomatic infection

For asymptomatic infection among children, the guidelines recommended no specific medication; instead, it promoted COVID-appropriate behaviour (mask, strict hand hygiene, physical distancing) and suggested giving a nutritious diet.

The guidelines said that for mild infection, paracetamol 10-15mg/kg/dose may be given every 4-6 hours for fever. Throat soothing agents and warm saline gargles in older children and adolescents have been recommended for cough.

In case of moderate infection, the guidelines suggested initiating immediate oxygen therapy.

“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.

For severe COVID among children, the guidelines said if Acute Respiratory Distress Syndrome (ARDS) develops, necessary management should be initiated.

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

6-minute 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.