Current management of children with COVID-19 in hospitals in India; Pilot study and findings

Introduction: To date, the focus on COVID-19 among children, especially in low- and middle-income countries, has been to address key issues including poor vaccination rates. However, the focus is changing with new variants and concerns regarding the development of hyperinflammatory syndromes. There have also been concerns with the overuse of antibiotics to treat patients with COVID-19, with the Indian Government developing guidelines, including those for children, to improve patient care. Consequently, a need to document the current management of children with COVID-19 in India and use the findings for future guidance. Materials and Methods: Pilot study assessing the management of children with COVID-19 among five hospitals in India using purposely developed case report forms, which had been piloted in Bangladesh. Results: Low numbers of children in hospital with COVID-19 (11.9% of in-patient beds). The majority were boys (58.3%) and between 11 and 18 years (55.5%). Reasons for admission were in line with previous studies and included respiratory distress/breathing difficulties. 69.4% of children with COVID-19 were prescribed antibiotics empirically, typically those on the Watch list, and administered parenterally, with only limited switching to oral therapy. A minority were prescribed antimalarials, antivirals and anti-parasitic medicines. There was appreciable prescribing of immune boosters and steroids. Conclusion: It was encouraging to see low hospitalisation rates. However, concerns with high empiric use of antibiotics and limited switching to oral formulations need to be addressed potentially, by instigating antimicrobial stewardship programmes. Similarly, other antimicrobials where these are not recommended.