COVID-19 and Paediatric Dosing

Reference	Lopinavir/Ritonavir (Kaletra) 200mg/50mg Tablet Lopinavir/Ritonavir (Kaletra) 80mg/20 mg per mL Syrup	Hydroxychloroquine Sulphate 200 mg (Plaquenil or Uniquin)		Ribavirin 200 mg  (Copegus)
Hospital Kuala Lumpur [HKL] Updated 20.03.20	Age 14 days to 6 months: Lopinavir component 16 mg/kg BD (or 0.2 mL/kg BD) Age 6 months to 18 years: ·   15-25 kg: 200mg/50mg 2.5mL syrup or 1 tab BD ·   26-35 kg: 300 mg/75 mg (3.75mL) BD ·   >35 kg: 400 mg/100 mg 5mL or 2 tabs BD	<18 years: 10 mg/kg (max: 400 mg/dose) BD x 1 day then 3 mg/kg (max: 200 mg/dose) BD		-
Hospital Umum Sarawak [HUS] Updated 23.03.20	2wk – 6 mth: 16mg/4mg LPV/r per kg BD (0.2 mL/kg BD) 6 months – 18 years: § 7 to <15kg: 12mg/kg/dose BD (0.15 mL/kg BD) § 15-40kg: 10mg/kg/dose BD (0.125 mL/kg BD) ; Max 400mg/100mg BD § >40kg: As per adult dosing: 2 tabs BD or 5 mL BD	Tablet / Extemporaneous suspension: Day 1: 5-6 mg/kg/dose BD (Max 400mg/dose) Day 2-5: 1.5-3 mg/kg/dose BD (Max 200mg/dose) Prepare oral suspension of 25mg/ml: 15 tabs to 120ml of X-temp. Keep in amber bottle, stable at room temperature (25 ± 2°C) for 90 days.		-
UptoDate: Refer to Drug Information for each individual drug(s) Accessed 13.04.2020	Lopinavir/ritonavir is currently under investigation for use in the treatment of coronavirus disease 2019 (COVID-19). At this time, safety and efficacy have NOT been established in adult or pediatric patients.	Hydroxychloroquine sulfate 200 mg is equivalent to 155 mg hydroxychloroquine base.  Children and Adolescents: Oral: 6.5 mg/kg/dose twice daily on day 1; maximum day 1 dose: 400 mg/dose; followed by 3.25 mg/kg/dose twice daily on days 2 through 5; maximum dose: 200 mg/dose (ASTCT 2020) Note: These dosing recommendations are specifically for patients who have undergone hematopoietic cell transplant (HCT) or other cellular therapy. However, some centers are reporting internal protocols/plans to use this dose in hospitalized pediatric patients who are not HCT patients.		At this time, while there are a number of medicines being investigated for treatment and/or prevention of COVID-19, none have yet to demonstrate safety and efficacy in humans diagnosed with or exposed to COVID-19.
An Algorithmic Approach to Diagnosis and Treatment of Coronavirus Disease 2019 (COVID-19) in Children: Iranian Expert’s Consensus Statement Updated 05.03.20	All dosing based on lopinavir: 14 days to 12 months: 16 mg/kg/dose BD PO or 300 mg/m2/dose BD PO 12 months to 18 years: v  Based on BSA: 230 mg/m2/dose BD PO (max 400 mg BD PO) v  Based on weight: Ø  Less than 15 kg: 12 mg/kg/dose BD PO Ø  15-40 kg: 10 mg/kg/dose BD PO Ø   Greater than 40 kg: 2 tabs BD PO (1 tab = 200/50)	IV, hydroxychloroquine sulfate: Infants and children 3-5 mg/kg/day (max dose 400 mg), BID For 5 days [No oral HCQ recommendation, only IV available]		Over 3 years old: ü  < 47 kg: 7.5 mg/kg BD ü  47-59 kg: 400 mg BD ü  60-73 kg: 400 mg OM, 600 mg ON ü  > 73 kg: 600 mg BD For up to 14 days, depends on patient’s response.
Michigan Medicine: Emergency Department Guidance for Treatment of COVID-19 in Adults and Children Updated 25.03.20	-	All doses are for < 18 years old. Admitted / Pending admission: *10 mg/kg (max: 600 mg/dose) PO BID x2 (load), then 3 mg/kg PO TID (max: 200 mg/dose) *Minimum 5 days; may be extended if slow clinical improvement or clinical worsening Discharged from emergency department: *8 mg/kg PO BID x2 doses (max: 400 mg/dose), then 4 mg/kg PO BID (max: 200 mg/dose)  *Total 5 days		-
Caution(s) / Remark(s)	ž Dispense in amber bottles.[HUS] ž   May consume with sweets or tangy food (e.g. orange juice, chocolate syrup) to improve palatability.[HUS] ž Caution: Syrup contains 42.4% ethanol and 15.3% ethylene glycol, hence potentially incompatible with polyurethane feeding tubes [HKL] ž Hence for oral solution (NG tube feeding): Only use silicone & polyvinyl chloride (PVC) feeding tube. [HKL/HUS] ž Administer UNDILUTED / PURE. Rinse feeding tube with milk (NOT water). [HKL/HUS] ž For adult or child > 40 kg that uses tablet in tube feeding:      Exposure of Lopinavir can be reduced by 45% when the tablet is crushed      May increase to 3 or 4 tabs BD x 10-14 days [HKL/HUS] ž Caution with GI symptoms and liver function [HUS] ž Generally for 5 - 14 days, depends on physician’s judgment.[Iran]	ž  Tablet can be crushed and dispersed in water.[HUS] ž  ECG prior to starting chloroquine and after onset of drug, cardiac monitoring is recommended [Iran] ž Use with caution in patient at risk for QT prolongation [Michigan]		For NG tube feeding: Tablet can be crushed. However use double glove and protective gown, as drug has teratogenic potential to men and women trying to conceive (Ensure precautionary notes is attached).[HUS]
	May enhance QT-prolonged effect when ≥2 of the following administered together: AMIODARONE, Azithromycin, Ciprofloxacin, Fluconazole, Chloroquine, Hydroxychloroquine, Kaletra®
* Off-label Treatment Patient Consent Form is needed. * So far there is no established paediatric dosing of ribavirin, interferon beta 1b and tocilizumab for COVID-19.			Updated 13.04.2020 by JCK Ho (Hospital Keningau)

ANYHOW THIS IS JUST A ROUGH GUIDANCE THAT MAY ASSIST YOU DURING SCREENING.

EVENTUALLY, PLEASE FOLLOW THE DOSING PRESCRIBED BY OUR PAEDIATRIC ID (Infectious Disease) TEAM.

FOR HEALTHCARE PROFESSIONAL USE ONLY