El-Chaar Gladys
Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, Queens, New York, USA.
Department of Pharmacy, NYU Langone - Long Island, Mineola, New York, USA.
Pediatr Allergy Immunol Pulmonol. 2020 Dec;33(4):177-189. doi: 10.1089/ped.2020.1241.
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic is a health care emergency across the world. Although mitigation measures, such as social distancing and face masks, have attempted to slow the spread of the infection, cases continue to rise. Children who are otherwise healthy tend to develop a milder acute Coronavirus disease 2019 (COVID-19) infection and have lower mortality rates compared with adults. Guidelines and current primary and secondary literature on the treatment of COVID-19 and the multisystem inflammatory syndrome in children were searched and reviewed. There are 6 published pediatric series that included 252 children with acute COVID-19 infection and describe various treatments and outcomes. Guidelines recommend treating pediatric patients similarly to adult patients. Currently, no prophylactic drug therapy has been shown to reduce the spread of infection. Treatment options for acute COVID-19 are limited to remdesivir and glucocorticoids for patients who require oxygen and/or mechanical ventilation. The efficacy of hydroxychloroquine, chloroquine, and azithromycin has not been proven and their safety has been a concern. Other therapies that are being explored include interleukin (IL)-1 and IL-6 inhibitors. In children, an atypical Kawasaki-like disease emerged after recent exposure to SARS-CoV-2 and has been named Multisystem Inflammatory Syndrome in Children (MIS-C). Nine case series, including 418 pediatric patients, described pharmacotherapies used and patient outcomes. These pharmacotherapies included intravenous immune globulin and glucocorticoids and in some patients, IL-1 and IL-6 inhibitors. Given the paucity of data in children, this article presents currently recommended pharmacotherapies for the treatment of acute COVID-19 infection in adult patients and whenever available, in pediatric patients. Pharmacotherapies used in the treatment of MIS-C in children are also reviewed.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行是一场全球性的医疗保健紧急事件。尽管诸如社交距离和口罩等缓解措施试图减缓感染的传播，但病例仍在不断增加。与成年人相比，原本健康的儿童往往会感染症状较轻的2019冠状病毒病（COVID-19），且死亡率较低。检索并综述了关于COVID-19治疗以及儿童多系统炎症综合征的指南和当前的一级与二级文献。有6篇已发表的儿科系列文章，纳入了252例急性COVID-19感染儿童，并描述了各种治疗方法和结果。指南建议对儿科患者的治疗与成人患者相似。目前，尚未证明有任何预防性药物疗法能减少感染的传播。对于需要吸氧和/或机械通气的急性COVID-19患者，治疗选择仅限于瑞德西韦和糖皮质激素。羟氯喹、氯喹和阿奇霉素的疗效尚未得到证实，其安全性也一直令人担忧。正在探索的其他疗法包括白细胞介素（IL）-1和IL-6抑制剂。在儿童中，近期接触SARS-CoV-2后出现了一种非典型的川崎样疾病，并被命名为儿童多系统炎症综合征（MIS-C）。9个病例系列，包括418例儿科患者，描述了所使用的药物疗法和患者结局。这些药物疗法包括静脉注射免疫球蛋白和糖皮质激素，在一些患者中还使用了IL-1和IL-6抑制剂。鉴于儿童数据的匮乏，本文介绍了目前推荐的用于治疗成人急性COVID-19感染以及在可行时用于儿科患者的药物疗法。本文还综述了用于治疗儿童MIS-C的药物疗法。
