Pilot study on the current management of children with COVID-19 in hospitals in Bangladesh; findings and implications

Objective: The focus on COVID-19 in children in low- and middle-income countries including Bangladesh has been on addressing key issues including poor vaccination rates as well as mental health issues, domestic violence and child labour. However, the focus on optimally managing children in hospitals is changing with new variants and concerns with the development of hyperinflammatory syndromes. There are also concerns with the overuse of antimicrobials to treat patients with COVID-19 in hospitals enhancing resistance rates. The Bangladesh Paediatric Association have developed guidelines to improve patient care building on national guidance. Consequently, there is a need to document the current management of children with COVID-19 in Bangladesh and use the findings for future guidance. Methods: Rapid analysis of the management of children with COVID-19 among eight private and public hospitals in Bangladesh with varying numbers of in-patient beds using purposely developed case report forms (CRFs). The CRFs were piloted before full roll-out. Results: Overall low numbers of children in hospital with COVID-19 (4.3% of in-patient beds). The majority were male (59.6%) and aged 5 years or under (63.5%). Reasons for admission included respiratory distress/ breathing difficulties with 94.2% of COVID-19 cases confirmed. All children were prescribed antibiotics empirically, typically those on the Watch list of antibiotics and administered parenterally, with only a small minority switched to oral therapy before discharge. There was appreciable prescribing of Vitamins (C and D) and zinc and encouragingly limited prescribing of other antimicrobials (antivirals, antimalarials and antiparasitic medicines). Length of stay was typically 5 to 10 days. Conclusion: Encouraging to see low hospitalisation rates and limited use of antimicrobials apart from antibiotics. Concerns with high empiric use of antibiotics and limited switching to oral formulations can be addressed by instigating antimicrobial stewardship programmes. We will be monitoring this

Targeting specific checkpoints in the management of SARS-CoV-2 induced cytokine storm

COVID-19-infected patients require an intact immune system to suppress viral replication and prevent complications. However, the complications of SARS-CoV-2 infection that led to death were linked to the overproduction of proinflammatory cytokines known as cytokine storm syndrome. This article reported the various checkpoints targeted to manage the SARS-CoV-2-induced cytokine storm. The literature search was carried out using PubMed, Embase, MEDLINE, and China National Knowledge Infrastructure (CNKI) databases. Journal articles that discussed SARS-CoV-2 infection and cytokine storm were retrieved and appraised. Specific checkpoints identified in managing SARS-CoV-2 induced cytokine storm include a decrease in the level of Nod-Like Receptor 3 (NLRP3) inflammasome where drugs such as quercetin and anakinra were effective. Janus kinase-2 and signal transducer and activator of transcription-1 (JAK2/STAT1) signaling pathways were blocked by medicines such as tocilizumab, baricitinib, and quercetin. In addition, inhibition of interleukin (IL)-6 with dexamethasone, tocilizumab, and sarilumab effectively treats cytokine storm and significantly reduces mortality caused by COVID-19. Blockade of IL-1 with drugs such as canakinumab and anakinra, and inhibition of Bruton tyrosine kinase (BTK) with zanubrutinib and ibrutinib was also beneficial. These agents' overall mechanisms of action involve a decrease in circulating proinflammatory chemokines and cytokines and or blockade of their receptors. Consequently, the actions of these drugs significantly improve respiration and raise lymphocyte count and PaO2/FiO2 ratio. Targeting cytokine storms' pathogenesis genetic and molecular apparatus will substantially enhance lung function and reduce mortality due to the COVID-19 pandemic.https://www.mdpi.com/journal/lifeam2023Pharmacolog

The response to COVID 19 across countries and the implications for future pandemics

We have previously reported that COVID-19 was first identified in Wuhan, China, in December 20191-4. By mid-August 2021, there were over 208 million confirmed cases worldwide with more than 4.3 million deaths giving a case fatality ratio of 2.1%5. Since COVID-19 is principally spread through airborne aerosols and physical contact6-8, and an appreciable number of patients are asymptomatic, early strategies to prevent the spread of the virus in the absence of proven effective medicines included lockdown and other preventative measures4,9

Current management of children with COVID-19 in hospitals in India; pilot study and findings

Introduction: To date, the focus on COVID-19 among children especially in low- and middle-income countries has been to address key issues including poor vaccination rates. However, the focus is changing with new variants and concerns regarding the development of hyperinflammatory syndromes. There have also been concerns with the overuse of antibiotics to treat patients with COVID-19, with the Indian Government developing guidelines, including those for children, to improve patient care. Consequently, a need to document the current management of children with COVID-19 in India and use the findings for future guidance. Methodology: Pilot study assessing the management of children with COVID-19 among five hospitals in India using purposely developed case report forms (CRFs), which had been piloted in Bangladesh. Results: Low numbers of children in hospital with COVID-19 (11.9% of in-patient beds). The majority were male (58.3%) and between 11 to 18 years (55.5%). Reasons for admission were in line with previous studies and included respiratory distress/ breathing difficulties. 69.4% of children with COVID-19 were prescribed antibiotics empirically, typically those on the Watch list, and administered parenterally, with only limited switching to oral therapy. A minority were prescribed antimalarials, antivirals, and anti-parasitic medicines. There was appreciable prescribing of immune boosters and steroids. Conclusion: Encouraging to see low hospitalisation rates. However, concerns with high empiric use of antibiotics and limited switching to oral formulations need to be addressed potentially by instigating antimicrobial stewardship programmes. Similarly, other antimicrobials where these are not recommended

Targeting Specific Checkpoints in the Management of SARS-CoV-2 Induced Cytokine Storm

COVID-19-infected patients require an intact immune system to suppress viral replication and prevent complications. However, the complications of SARS-CoV-2 infection that led to death were linked to the overproduction of proinflammatory cytokines known as cytokine storm syndrome. This article reported the various checkpoints targeted to manage the SARS-CoV-2-induced cytokine storm. The literature search was carried out using PubMed, Embase, MEDLINE, and China National Knowledge Infrastructure (CNKI) databases. Journal articles that discussed SARS-CoV-2 infection and cytokine storm were retrieved and appraised. Specific checkpoints identified in managing SARS-CoV-2 induced cytokine storm include a decrease in the level of Nod-Like Receptor 3 (NLRP3) inflammasome where drugs such as quercetin and anakinra were effective. Janus kinase-2 and signal transducer and activator of transcription-1 (JAK2/STAT1) signaling pathways were blocked by medicines such as tocilizumab, baricitinib, and quercetin. In addition, inhibition of interleukin (IL)-6 with dexamethasone, tocilizumab, and sarilumab effectively treats cytokine storm and significantly reduces mortality caused by COVID-19. Blockade of IL-1 with drugs such as canakinumab and anakinra, and inhibition of Bruton tyrosine kinase (BTK) with zanubrutinib and ibrutinib was also beneficial. These agents\u27 overall mechanisms of action involve a decrease in circulating proinflammatory chemokines and cytokines and or blockade of their receptors. Consequently, the actions of these drugs significantly improve respiration and raise lymphocyte count and PaO2/FiO2 ratio. Targeting cytokine storms\u27 pathogenesis genetic and molecular apparatus will substantially enhance lung function and reduce mortality due to the COVID-19 pandemic

Management of children admitted to hospitals across Bangladesh with suspected or confirmed COVID-19 and the implications for the future : a nationwide cross-sectional study

There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO 'Watch' list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes

Management of children admitted to hospitals across Bangladesh with suspected or confirmed COVID-19 and the implications for the future : a nationwide cross-sectional study

There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO ‘Watch’ list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.Supplementary Material : File S1: Bangladesh: COVID-19 Pediatric Case Management.http://www.mdpi.com/journal/antibioticsPharmacolog

Management of children admitted to hospitals across Bangladesh with suspected or confirmed COVID-19 and the implications for the future : a nationwide cross-sectional study

There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO 'Watch' list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes