Use of antivirals or monoclonal antibodies is not recommended for those less than 18 years of age, irrespective of severity of COVID-19 infection, and if steroids are used, they should be tapered over 10 to 14 days, subject to clinical improvement, the government said on Thursday, January 20. In the 'Revised Comprehensive Guidelines for Management of COVID-19 in Children and Adolescents (below 18 years)', the Health Ministry also said that masks are not recommended for children aged five years and below.
Those aged 6-11 years may wear it depending on the ability of the child to use a mask safely and appropriately under direct supervision of parents, it said. Those aged 12 and above should wear a mask under the same conditions as adults, the ministry said. The guidelines were reviewed by a group of experts in view of the current surge that is mainly attributed to the Omicron variant of the coronavirus, which is also a variant of concern.
The available data from other countries suggests 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, the ministry said. It categorised cases as asymptomatic, mild, moderate and severe. According to the guidelines, COVID-19 is a viral infection and antimicrobials have no role in the management of uncomplicated COVID-19 infection.
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 superadded infection, the ministry said.
In case of septic shock, empirical antimicrobials, according to body weight, are frequently added to cover all likely pathogens based on clinical judgement, patient host factors, local epidemiology and antimicrobial policy of the hospital, it said. The guidelines stated that steroids are not indicated and are harmful in asymptomatic and mild cases of COVID-19.
They are indicated only in hospitalised severe and critically ill COVID-19 cases under strict supervision, the guidelines said. Steroids should be used at the right time, in the right dose and for the right duration, they stated. Corticosteroids may be used in rapidly progressive moderate and all severe cases, such as dexamethasone 0.15 mg/kg, maximum dose six mg once a day or methylprednisolone 0.75 mg/kg, maximum dose 30 mg once a day, the guidelines stated. They can be continued for five to seven days and tapered up to 10-14 days, depending on clinical assessment on a daily basis, they stated.
Steroids should be avoided in the first three to five days since onset of symptoms as it prolongs viral shedding, the guidelines stated. Anticoagulants are not indicated routinely and all hospitalised children should be evaluated for risk of developing thrombosis and monitored for development of thrombosis, the ministry said.
As far post-COVID-19 care is concerned, the guidelines stated that children with asymptomatic infection or mild disease should receive routine childcare, appropriate vaccination (if eligible), nutrition counselling, and psychological support on follow up.
In addition to the above, parents or caregivers of children, who suffered moderate to severe COVID-19, during discharge from hospital should be counselled regarding monitoring for persistence or worsening respiratory difficulty and explained the indications for bringing the child back to the facility, the guidelines stated. Children who develop any organ specific dysfunction during hospital stay or subsequently, should receive appropriate care, they said. These guidelines are dynamic, and will be reviewed and updated, on availability of new evidence, the ministry stated.