Treatment Options for Pediatric COVID Patients

Treatment options are very limited in the outpatient settings for children, similar to adults.

Passive Immunization (Prevention) for lmmunocompromised Hosts

Tixagevimab + Cilagavimab (Evusheld; AstraZeneca)

  • Approved for pre-exposure prophylaxis down to age 12 years (􀀆12 y) and 􀀆40 kg\
  • Administered by 2 separate (same visit) IM injections
  • May repeat dosage after 6 months


  • Not currently infected or recently exposed to someone with SARS-CoV-2, AND EITHER
  • Moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatment AND thus may not be able to mount an adequate immune response to the virus, OR
  • Have a history of adverse reaction to a COVID vaccine(s) and thus cannot be administered any additional indicated doses of COVID vaccine (e.g., recommended second dose or booster)

Oral antiviral therapy [ slide.pdf]


Combination of Nirmatrelvir (a viral protease inhibitor) and Ritonavir (used as a CYP3A inhibitor to boost/prolong nirmatrelvir plasma levels; it has not anti-coronavirus activity)

Dosage= two 150 mg tablets (300 mg/dose) of nirmatrelvir by mouth twice a day for 5 days, with one 100 mg tablet of ritonavir taken with each dose of nirmatrelvir

  • Supplied as five blister packs, one for each of 5 days of treatment
  • May be taken without regard to food/having eaten recently or not
  • Ritonavir may increase risk of drug interactions
  • Side effects generally mild, not frequent
  • Best effect is as soon as possible after onset of COVID-19 symptoms, and should be started within the first 5 days on symptom onset
  • Dosage adjustment required in renal failure
  • Reduced risk of hospitalization or death from 6.3% to 0.8% (88% reduction; from 1 in 16 to 1 in 1250)

FDA Emergency Use Authorization is for adults plus children 12 years of age and older who weigh at least 40 kg who

For information on drug interactions, see


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