Faculty of Medicine, American University of Beirut Medical Center, Riad El Solh, 11-0236, Beirut, 1107 2020, Lebanon.
Department of Pediatrics, Division of Pediatric Cardiology, American University of Beirut Medical Center, Riad El Solh, 11-0236, Beirut, 1107 2020, Lebanon.
Pharmacol Rep. 2021 Dec;73(6):1520-1538. doi: 10.1007/s43440-021-00316-1. Epub 2021 Aug 30.
The global spread of COVID-19 has imparted significant economic, medical, and social burdens. Like adults, children are affected by this pandemic. However, milder clinical symptoms are often experienced by them. Only a minimal proportion of the affected patients may develop severe and complicated COVID-19. Supportive treatment is recommended in all patients. Antiviral and immunomodulatory medications are spared for hospitalized children with respiratory distress or severe to critical disease. Up till now, remdesivir is the only USFDA-approved anti-COVID-19 medication indicated in the majority of symptomatic patients with moderate to severe disease. Dexamethasone is solely recommended in patients with respiratory distress maintained on oxygen or ventilatory support. The use of these medications in pediatric patients is founded on evidence deriving from adult studies. No randomized controlled trials (RCTs) involving pediatric COVID-19 patients have assessed these medications' efficacy and safety, among others. Similarly, three novel monoclonal anti-SARS-CoV-2 spike protein antibodies, bamlanivimab, casirivimab and imdevimab, have been recently authorized by the USFDA. Nonetheless, their efficacy has not been demonstrated by multiple RCTs. In this review, we aim to dissect the various potential therapeutics used in children with COVID-19. We aspire to provide a comprehensive review of the available evidence and display the mechanisms of action and the pharmacokinetic properties of the studied therapeutics. Our review offers an efficient and practical guide for treating children with COVID-19.
COVID-19 在全球范围内的传播给经济、医疗和社会带来了巨大的负担。和成年人一样，儿童也受到了这种大流行的影响。但他们往往表现出较轻的临床症状。只有一小部分受影响的患者可能会发展成严重和复杂的 COVID-19。所有患者均建议给予支持性治疗。对于有呼吸窘迫或严重至危重症的住院患儿，建议使用抗病毒和免疫调节药物。迄今为止，瑞德西韦是美国食品药品监督管理局（FDA）唯一批准的用于大多数有症状的中度至重度疾病患者的抗 COVID-19 药物。仅建议在需要吸氧或通气支持的呼吸窘迫患者中使用地塞米松。这些药物在儿科患者中的使用是基于来自成人研究的证据。没有随机对照试验（RCT）评估这些药物在儿科 COVID-19 患者中的疗效和安全性等。同样，美国 FDA 最近批准了三种新型单克隆抗 SARS-CoV-2 刺突蛋白抗体：bamlanivimab、casirivimab 和 imdevimab。但它们的疗效尚未经过多项 RCT 证实。在这篇综述中，我们旨在剖析用于治疗 COVID-19 患儿的各种潜在治疗方法。我们旨在全面回顾现有证据，并展示研究治疗药物的作用机制和药代动力学特性。我们的综述为治疗 COVID-19 患儿提供了一种高效实用的指南。
