Comparison of COVID-19-specific treatments for children and nonpregnant* adolescents in the outpatient setting

Agent	Time window for initiation after symptom onset^¶	Age of approval/ authorization	Route and duration of administration	Clinical considerations
Nirmatrelvir-ritonavir	≤5 days	≥12 years and weight ≥40 kg	Oral 5 days (twice daily)	Significant drug-drug interactions with many common medications; consult a reliable prescribing reference^Δ to determine if nirmatrelvir-ritonavir use is appropriate or if risk can be safely mitigated with alteration of the patient's medication regimen Reduce dose for eGFR 30 to 59 mL/min; avoid use in eGFR <30 mL/min and in severe hepatic impairment Tablets cannot be chewed, broken, or crushed Data in children are limited
Remdesivir	≤7 days	≥28 days and weight ≥3 kg	Parenteral 3 days	For use in patients for whom other authorized or approved therapies are not accessible or clinically inappropriate
Molnupiravir	≤5 days	≥18 years	Oral 5 days (twice daily)	Avoid in pregnancy and in those at risk of pregnancy due to potential adverse effects on developing fetus Sexually active males with partners who may become pregnant should use effective contraception during and for 3 months after last molnupiravir dose Lower reported efficacy than other therapies Swallow capsules whole; do not open, break, or crush

This table summarizes COVID-19-specific treatments for children and nonpregnant adolescents in the outpatient setting. The decision to prescribe COVID-19 specific therapy is based upon the patient's risk for progression to severe disease and includes an assessment of risk factors (eg, underlying comorbidities) and immunization status. Refer to UpToDate content on management of COVID-19 in children for details, including doses and additional considerations. Additional information with links to fact sheets or prescribing information is available in a side-by-side overview from the United States Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response.

COVID-19: coronavirus disease 2019; eGFR: estimated glomerular filtration rate; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.

* Refer to UpToDate content on care of pregnant patients with COVID-19.

¶ We encourage initiation of treatment as soon as possible after symptom onset and within the authorized/approved time windows provided in the table. The first day of symptoms is considered day 0, the next day is considered day 1, etc.

Δ As an example, the PAXLOVID Patient Eligibility Screening Checklist Tool for Prescribers from the US Food and Drug Administration.

Reference: United States Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. Side-by-side overview of therapeutics authorized or approved for the prevention of COVID-19 Infection or treatment of mild-moderate COVID-19. Available at: aspr.hhs.gov/COVID-19/Therapeutics/Pages/default.aspx (Accessed on June 30, 2022).

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Comparison of COVID-19-specific treatments for children and nonpregnant* adolescents in the outpatient setting