Pharmacotherapeutic options for children with COVID-19: a narrative review

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic with major concerns on finding effective ways for clinical management. In this review, we searched available publications on the pharmacological treatment options for children with COVID-19. In total, 104 case reports and 15 cohort studies were included for analysis. For children, commonly applied medications were categorized into five main types: antivirals, antibacterials and antifungals, anti-inflammatories, anticoagulants, and vasopressors. Inhaled interferon was the most used antiviral in cohort studies, while hydroxychloroquine (HCQ) or chloroquine (CQ) was the most in case reports. Different from adult patients, special consideration should be given to COVID-19 children diagnosed with multisystem inflammatory syndrome (MIS-C). Besides direct antiviral treatment, pharmacological care managing the inflammatory process comprises a great part of the treatment protocol. In addition to commonly used glucocorticoids, intravenous immunoglobulin (IVIG), and aspirin, some biologics could be considered as potential treatment. Anakinra, an interleukin-1 (IL-1) receptor antagonist, is highly recommended by the American College of Rheumatology as a safe treatment for children with MIS-C. The IL-6 receptor antagonist, tocilizumab, is also a potential treatment option. This review offers a comprehensive overview of the common medications used in clinical settings all over the world, but should be referred to with caution and flexibility depending on the actual condition of a specific patient. © Pediatric Medicine. All rights reserved.