Drugs such as ivermectin, hydroxychloroquine, favipiravir and antibiotics like doxycycline and azithromycin prescribed for adult COVID-19 patients have not been recommended for treating children, according to a government guideline issued on Wednesday.

In anticipation of likely intermittent surges in the number of COVID-19 cases, the government has come out with guidelines for operationalizing Covid-care services for children.

The recommendations include augmenting existing Covid care facilities to provide care to children with acute coronavirus infection.

According to it, once vaccines are approved for children, those with comorbid conditions having more severe manifestations of COVID-19 and poorer outcomes should be a priority group for immunisation.

About the treatment of children, the guidelines by the Union Health Ministry said most drugs used in adults such as ivermectin, hydroxychloroquine, favipiravir and antibiotics such as doxycycline or azithromycin have not been tested on children for prevention or treatment of Covid infection among them.

"Therefore, these are not recommended in children."

The guidelines stated it is anticipated that there may be intermittent surges in the number of coronavirus cases.

"A combined effort from the private and public sector is needed to handle any surge (in cases) in the future after the withdrawal of the lockdown, school reopening or as a third wave over the next three to four months. The basic principles of equity and dignity of care should be followed," it said.

The guidelines said estimates for additional bed capacity for pediatric care may be calculated based on peak daily cases in different districts during the second wave of the COVID-19 infections.

From this, projections for pediatric cases and the number of admissions required can be derived, it said.

"It is desirable to augment the existing Covid-care facilities to provide care to children with acute Covid. This will need additional pediatric-specific equipment, infrastructure, and pediatric formulations.

"Also, an adequate number of trained manpower -- both doctors and nurses -- should be provided. The health authorities should initiate capacity-building programs for appropriate pediatric care. In standalone pediatric hospitals, separate arrangements, for example, separate beds for pediatric Covid care need to be set up," the guidelines said.

It is desirable to designate specific areas in the Covid facilities for pediatric care and parents should be allowed to accompany the child there.

"For children with Multisystem Inflammatory Syndrome who test negative for acute Covid, care has to be provided by the existing pediatric facilities. These facilities also need augmentation especially HDU and ICU services," it said.

The document provides guidance about additional requirements for infrastructure, equipment and manpower.

Noting that a majority of children have asymptomatic or mild illness and can be managed at home by parents, it said treatment for symptomatic patients include paracetamol for fever and monitoring conditions such as measuring respiratory rates, difficulty in respiration, oral intake and oxygen saturation.

"In a community setting, ASHA and MPW should be involved for management of children at home and also monitor to assess the need for referral and admission," the guidelines said.

The document stressed on imparting training to community health workers for picking up the red flag signs. Also, all stakeholders, including the community, should be educated by the information education communication.

For improving the quality of care and for capacity building, the guidelines recommended hand-holding of district hospitals and other facilities by medical colleges.

"A few centres may be designated as regional centres of excellence for Covid care and research. These centres can provide leadership in clinical management and training. Telemedicine could be harnessed for reaching out to a large number of facilities," it said.

To ensure data collection at all levels and transmission from community to higher centres, the document recommended that a national registry be launched for pediatric Covid.

"There is a need to encourage and facilitate research in the area of pediatric Covid and this could cover various aspects of management. Similarly, issues of optimal treatment for MIS-C need to be addressed by clinical trials, such as comparison of low dose with high doses steroids, comparison of steroids with IVIG and others," it added.

The guidelines said that based on sero-surveillance reports, COVID-19 infection in children above 10 years of age occurs in a similar frequency to that of adults, even though among the confirmed cases less than 12 per cent are individuals less than 20 years of age.

"Children have less severe disease than adults. In the majority, the infection is asymptomatic or mildly symptomatic. It is uncommon to have moderate to severe Covid among healthy children," it noted.