Centre discourages use of Remdesivir in treatment of Covid-19 in children in latest guidelines
“There is lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age,” according to the guidelines.
The Centre has set out comprehensive guidelines for the management of Covid-19 in children, according to which, Remdesivir drug has not been recommended for usage and also, the rational use of HRCT imaging (CT scan) has been suggested. The Directorate General of Health Services (DGHS) under the union ministry of health and family welfare, issued the new guidelines. It also said that the usage of steroids in treating asymptomatic and mild cases of infection is harmful.
Also, usage of steroids was recommended under “strict supervision” only for hospitalised moderately severe and critically ill Covid-19 cases. “Steroids should be used at the right time, in the right dose and for the right duration. Self-medication of steroids must be avoided,” the DGHS said.
Remdesivir, an emergency use authorization drug, is not recommended for treatment of children, the new guidelines also said. “There is lack of sufficient safety and efficacy data with respect to Remdesivir in children below 18 years of age,” according to the guidelines. The drug has been used to treat Covid-19 patients and its demand ballooned during the second wave of Covid-19 in India.
Suggesting only a rational usage of high-resolution CT (HRCT) scan for knowing the extent and nature of lung involvement in Covid-19 positive patients, 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. Therefore, treating physicians should be highly selective in ordering HRCT imaging of the chest in Covid-19 patients.”
Meanwhile, the new guidelines also noted that antimicrobials have no role in the prevention or treatment of uncomplicated Covid-19 infection, which is a viral infection. However, the guidelines also noted that antimicrobials should not be prescribed for moderate and severe cases unless there is clinical suspicion of a superadded infection. It also clearly said that antimicrobials are not needed for treatment or prophylaxis in asymptomatic and mild cases.
Covid appropriate behaviour and a nutritious diet were suggested for asymptomatic infection in children while no specific medications were mentioned in the guidelines. For mild infection in older children and adolescents, paracetamol dose every four to six hours for fever and throat soothing agents and warm saline gargles for cough have been recommended. However, initiating immediate oxygen therapy has been recommended for moderate infections.
The guidelines also said that if acute respiratory distress syndrome (ARDS) develops in severe Covid-19 infected children, then necessary management needs to be initiated. It also recommended a six-minute walk test for those above 12 years of age under the supervision of parents or 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," the guidelines said.
(With inputs from PTI)