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Table 3e. Dosing Regimens for the Drugs Recommended for the Treatment of MIS-C

Last Updated: February 29, 2024

Table 3e. Dosing Regimens for the Drugs Recommended for the Treatment of MIS-C
 Dosing Regimens

For infants, children, and adolescents unless otherwise specified. 

The doses listed are for FDA-approved indications for other diseases or from reported experiences or clinical trials.

Adverse EventsMonitoring Parameters
Intravenous Immunoglobulin
IVIG 2 g/kg IBW IV (up to a maximum total dose of 100 g)
 
In the event of cardiac dysfunction or fluid overload, consider administering IVIG in divided doses (i.e., IVIG 1 g/kg IBW IV, up to 50 g daily for 2 doses).
  • Hypersensitivity
  • Fever
  • Chills
  • Flushing
  • Hemolytic anemia
  • Renal function
  • Urine output
  • CBC with differential
  • Infusion-related AEs
  • Anaphylaxis
  • Signs and symptoms of hemolysis
Methylprednisolone
Methylprednisolone 1–2 mg/kg IV every 12 hours
 
Intensification immunomodulatory therapy: If the patient does not respond to 1–2 mg/kg IV every 12 hours, increase the dose to 10–30 mg/kg/day IV for 1–3 days (up to a maximum of 1,000 mg/day).
 
Glucocorticoids should be tapered gradually after signs of clinical improvement. The duration of the taper will depend on the patient’s clinical status.
  • Adrenal suppression
  • Hyperglycemia
  • Sodium retention
  • Fluid retention
  • Leukocytosis
  • Immune suppression
  • Psychiatric disturbances
  • Blood pressure
  • CBC with differential
  • BMP
Anakinra Anakinra 5–10 mg/kg/day IV (preferred) or SUBQ in 1–4 divided doses
  • Headache
  • Fever
  • Hypersensitivity
  • Immune suppression
  • Transaminase elevation
  • Injection site reactions (for SUBQ)
  • CBC with differential
  • LFTs
  • SCr
Infliximab Infliximab 5–10 mg/kg IV for 1 dose
  • Infusion-related reaction
  • Headache
  • Immune suppression
  • Monitor vital signs every 2–10 minutes during infusion.
  • CBC with differential
Aspirin Aspirin 3–5 mg/kg PO once daily (up to a maximum of 81 mg)
  • Gastrointestinal ulcers
  • Hypersensitivity
  • Signs or symptoms of bleeding
  • Renal function
Enoxaparin For Prophylaxis
Aged >2 Months to <18 Years
  • 0.5 mg/kg SUBQ every 12 hours (up to maximum of 30 mg)

For Treatment
Aged >2 Months to <18 Years

  • 1 mg/kg SUBQ every 12 hours
  • Monitor antifactor Xa activity (treatment goal: 0.5–1 unit/mL).
  • Increased risk of bleeding
  • CBC with differential
  • Renal function