Charleston Reporter

The IDSA guidelines endorsed the use of steroids, commonly used to decrease inflammation, in both severe and critical cases of COVID-19 but recommended the antiviral remdesivir only for the severe group. Few studies have tested remdesivir in critical cases, and results have been mixed, said Teufel. Existing evidence generally supports its efficacy early in the illness. However, it is less clear that it benefits patients with critical disease who are on a ventilator, he said.

These guidelines were followed much more quickly than is typical for guidelines for non-COVID-19 diseases. The tremendous impact of COVID-19 on the health, cultures and finances of people worldwide certainly provided enough motivation for clinicians to be educated on the most effective treatment options, Teufel said. When more reliable data came out, the pediatricians listened.

“Generally, people did the right thing,” said Teufel. “They stopped using things that were unproven and started using things that were more proven.”

“Generally, people did the right thing. They stopped using things that were unproven and started using things that were more proven.” -- Ronald Teufel, M.D.

For instance, they began using steroids and remdesivir more and ivermectin and the antimalarial hydroxychloroquine less.

However, the use of steroids topped out at 82%, which is interesting because these medications are readily available, and providers are very familiar with their use, Teufel explained. The compliance with guideline recommendations for remdesivir was far lower. In about 59% of critical cases, pediatricians followed the guidelines and did not prescribe remdesivir. In about 55% of severe cases, they prescribed remdesivir, as the guidelines recommended. Adoption of all of these recommendations fell well short of the 90% or more typically expected for such guidelines.

Teufel would like to see those percentages tick up and reach a 90% adoption rate. However, he fears that percentages could instead drop as COVID is no longer in the news and top of everyone’s mind. He thinks that technology could be the answer. Building guideline-recommended order sets into the electronic health record across children’s hospitals would make it easier for pediatricians to prescribe the appropriate medications. Those order sets could be revised as guidelines evolve.

“COVID-19 will likely spike again over the next years,” said Teufel. “Let’s make sure we do the best we can to ensure our kids get great care.”

Reference

Julianne E. Burns, et al. Medications and adherence to treatment guidelines among children hospitalized with acute COVID-19. Pediatrics. August 2022; 150 (3): e2022056606. DOI: 10.1542/peds.2022-056606

About the Author

Calvin Blaschke

Calvin Blaschke is a Ph.D. candidate in Dr. Richard Drake’s lab, where he focuses on identifying cancer biomarkers using mass spectrometry.

Categories: COVID-19, Pediatrics, Research

Original source can be found here.