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Table 3a. Therapeutic Management of Nonhospitalized Children With COVID-19

Last Updated: December 28, 2022

Table 3a. Therapeutic Management of Nonhospitalized Children With COVID-19
Risk of Severe COVID-19Panel's Recommendations
Aged 12–17 yearsAged <12 years
Symptomatic, Regardless of Risk Factors
  • Provide supportive care (AIII).
    • Provide supportive care (AIII).
      High Riska,b
      • Use 1 of the following options (listed in order of preference):c
        • Ritonavir-boosted nirmatrelvir (Paxlovid) within 5 days of symptom onset (BIII)
        • Remdesivir within 7 days of symptom onset (CIII)
      • Ritonavir-boosted nirmatrelvir is not authorized by the FDA for use in children aged <12 years.
      • There is insufficient evidence to recommend either for or against the routine use of remdesivir. Consider treatment based on age and other risk factors.
      Intermediate Riskb,d
      • There is insufficient evidence to recommend either for or against the use of any antiviral therapy. Consider treatment based on age and other risk factors.
      • There is insufficient evidence to recommend either for or against the routine use of remdesivir.
      Low Riskb,e
      • Manage with supportive care alone (BIII).
      • Manage with supportive care alone (BIII).
      Each recommendation in the Guidelines receives 2 ratings that reflect the strength of the recommendation and the quality of the evidence that supports it. See Guidelines Development for more information.

      a Molnupiravir is not authorized by the FDA for use in children aged <18 years and should not be used.

      b See Table 3b for the Panel’s framework for assessing the risk of progression to severe COVID-19 based on patient conditions and COVID-19 vaccination status.

      c Initiate treatment as soon as possible after symptom onset.

      d The relative risk of severe COVID-19 for intermediate-risk patients is lower than the risk for high-risk patients but higher than the risk for low-risk patients.

      e Low-risk patients include those with comorbid conditions that have a weak or unknown association with severe COVID-19. Patients with no comorbidities are included in this group.

       

      Key: FDA = Food and Drug Administration; the Panel = the COVID-19 Treatment Guidelines Panel