The new guidelines supersedes the previous version on June 16, 2021. The Comprehensive Guidelines for Management of COVID-19 in children and adolescents below 18 years were reviewed in order to view of the current surge mainly attributed to the Omicron variant of concern. The available data from other countries suggest that the disease caused by the Omicron variant is less severe; however, there is a need for a careful watch, as the current wave evolves. These guidelines are dynamic, and will be reviewed and updated on availability of new evidence, according to the Union Ministry of Health and Family Welfare. Some attention has also been drawn to the ministry’s guidelines related to FAQs on the Omicron variant, revised guidelines for home isolation of mild/asymptomatic COVID-19 cases and vaccination of children between 15 and 18 years.
What are the recommendations for antivirals or monoclonal antibodies?
The use of antivirals or monoclonal antibodies is not recommended for children less than 18 years of age, irrespective of the severity of infection. “As of now in the absence of efficacy and safety data, the use of antivirals such as Remdesivir, Molnupiravir, Favipiravir, Fluvoxamine, and monoclonal antibodies such as Sotrovimab, Casirivimab + Imdevimab are not recommended for children less than 18 years of age irrespective of severity of illness,” is the specific recommendation made as part of the revised guidelines.
Is there any change in treatment?
According to the guidelines, COVID-19 is a viral infection and antimicrobials have no role in the management of uncomplicated COVID-19 infection.
The management of children remains the same. It categorized cases as asymptomatic, mild, moderate, and severe.
In asymptomatic and mild cases, antimicrobials are not recommended for therapy or prophylaxis, the ministry said.
In moderate and severe cases, antimicrobials should not be prescribed unless there is clinical suspicion of a super added infection, the ministry said.
Mainstay of treatment for fever is to give paracetamol 10 to 15 mg/kg/dose, which may be repeated every 4 to 6 hours. For cough, throat soothing agents and warm saline gargles in older children and adolescents have been advised. Ensuring oral fluids to maintain hydration and a nutritious diet is among the recommendations. No other COVID-19 specific medication is needed for mild cases.
Home isolation for asymptomatic/mild cases
The symptoms are much milder and the disease is not extending beyond 3 to 5 days. In children, the main symptoms are cough, cold, and fever. Sore throat symptoms are more prominent than wheezing. However, for mild cases RT-PCR tests are not being advised. Several pediatricians have told that they have instructed families to stay in isolation for a week. For moderate and severe cases, treatment should be given inside an hospital or a prescribed medical doctor. However, COVID-19 detection tests are required for the ones who are hospitalized.
Use of anticoagulants revised
The use of anticoagulants has been revised and if steroids are used then they should be tapered over 10 to 14 days, subject to clinical improvement. A new section on post-covid care has also been added. Steroids are indicated only in severely hospitalized and critically ill COVID-19 cases under strict supervision. Indications and recommended doses of corticosteroids have been given in the guidelines which may be used in rapidly progressive moderate and all severe cases- The guidelines have recommended the use for 5 to 7 days and then to taper up to 10 to 14 days, depending on clinical assessment on a daily basis. Avoid steroids in the first 3 to 5 days since onset of symptoms as it prolongs viral shedding, the guidelines have said. The prophylactic dose of low molecular weight heparin(anticoagulant) has been revised.
The guidelines included the fact that it is important to teach children and adolescents to follow COVID-19-appropriate behaviors like washing hands frequently, maintaining a 2-meter distance, wearing masks, and staying in open spaces and well-ventilated areas. The parents should ensure vaccination to adolescents of the age group of 15 to 18 years to decrease the risk of infection.
Masks are not recommended for children aged 5 years and under. Experts said that they do not wear it properly and may have some issues with breathing if there is underlying asthma or they could be playing. Some parents can be obsessed and force the child to wear the mask and hence it is not mandatory for the child below five to wear one. Children aged 6 to 11 years may wear a mask depending on the ability of the child to use a mask appropriately and safely, under direct supervision of parents. Children aged 12 years and over should wear a mask under the same conditions as adults. It is much important to ensure their hands are kept clean with soap and water, or an alcohol-based hand rub, while handling masks.
Source: Medindia
