COVID Disease — Therapies by Severity of Illness: Non-hospitalized Children — Clinical Pathway: All Settings

Active COVID-19, Clinical Pathway — All Settings

Therapies by Severity of Illness: Non-hospitalized Children

This guidance reflects the limited available evidence and the expert opinion of a multidisciplinary team from CHOP Infectious Diseases, Critical Care, Antimicrobial Stewardship, Oncology, the Dysregulated Immune Response Team (DIRT), Immunology, Emergency Medicine, Primary Care, Laboratory Medicine and Pharmacy. The guidance here is subject to change as new evidence becomes available. Clinicians should continue to tailor clinical decision making to the unique aspects of individual children while weighing the risks/benefit ratio of administering experimental therapies or therapies with limited pediatric data.

Treatment Recommendations for Non-hospitalized Children
Moderate/Severe Immunocompromise Other High-risk Patient Who is
Not Fully Vaccinated		 All Others, Regardless of Vaccine Status
Pre-exposure
  • COVID-19 vaccination per CDC Recommendations  
  • EVUSHELD™ is no longer FDA authorized for COVID-19 pre-exposure prophylaxis due to widespread resistance (> 90%) among currently circulating variants. EVUSHELD is therefore no longer available for administration at CHOP.
 COVID-19 vaccination per CDC Recommendations  
Exposed No available therapies No available therapies No available therapies
  • Asymptomatic, presymptomatic
    Positive PCR or antigen test only
 No available therapies No available therapies No available therapies
  • Mild symptoms attributable to COVID-19 (upper respiratory tract symptoms, cough, fever, fatigue), with no new or increased O2 requirement
  • Supportive Care
  • ≥ 12 years and ≥ 40 kg, consider nirmatrelvir-ritonavir (Paxlovid™)
  • Molnupiravir is generally not recommended and only available for adolescents ≥ 18 years old1
  • Steroids not recommended unless indicated for another condition
  • Remdesivir is not routinely recommended and not available for CHOP outpatients
  • Supportive Care
  • ≥ 12 years and ≥ 40 kg, consider nirmatrelvir-ritonavir (Paxlovid)
  • Molnupiravir is generally not recommended and only available for adolescents ≥ 18 years old1
  • Steroids not recommended unless indicated for another condition
  • Remdesivir is not routinely recommended and not available for CHOP outpatients
 Supportive care

References

  1. The efficacy of molnupiravir in reducing hospitalization and death from COVID-19 is uncertain, and there are significant potential toxicities. Use of this drug is not routinely recommended and should be considered only when antiviral therapy is strongly preferred, and other therapies are unavailable or contraindicated.