Chloroquine dosage regimen simulation for pediatric patients with coronavirus disease 2019

Abstract

around 180 million people worldwide were infected by COVID-19, the newly emerged pandemic disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), with an overall mortality rate as high as 2 percent 1 . Its major symptoms are fever, cough, sore throat, myalgia, and respiratory tract symptoms 2 . Pediatric COVID-19 cases are less severe than adults, with hospitalization in only 8 versus 165 per 100,000 cases. Despite its low severity among children, drug treatments for severe cases in this population are still needed. Moreover, the rapid viral clearance provided by early antiviral administration is one of the treatment strategies that might prevent multisystem inflammatory syndrome in children (MIS-C). This syndrome is a postinfection consequence that explicitly affects children. It affects about 0.4 percent of all pediatric COVID-19 cases, mainly found in school-aged children, and is relatively severe with a mortality rate of 2 to 4 percent 3 .CQ has been used for nearly a century as an antimalarial agent. It was recommended as part of compassionate use for COVID-19 treatment by early clinical practice guidelines (CPGs) [4][5][6] . Its potency was demonstrated by several in vitro tests 7-8 but efficacy was controversial in clinical trials 9-10 with a higher dose than the usual malaria dose. Consequently, in March 2020, the United States Food Drug Administration (USFDA) approved CQ and hydroxychloroquine (HCQ), its derivative, for Emergency Use Authorization (EUA) 11 . However, the EUA was then revoked in June 2020 12 . Furthermore, the current CPGs 13-14 have discouraged use of CQ/HCQ in adult and pediatric COVID-19 patients because of a lack of efficacy and safety concerns, as shown in some meta-analysis studies