To the Editor: COVID-19 is a mild illness in children and generally requires only symptomatic therapy. Antiviral therapy may be considered in children with COVID-19 pneumonia or those with risk factors for disease progression [1]. Remdesivir and monoclonal antibodies are the only approved treatments for children [1]. There is limited data on the safety and tolerability of remdesivir in children.

We included all children below 18 y with confirmed SARS-CoV-2 infection at our centre who received at least 1 dose of remdesivir from 2020-2022. Remdesivir was given after taking due consent as per standard doses [1]. Information regarding demographics, indications for remdesivir, adverse effects and outcomes was analysed.

A total of 21 children (15 boys) with age ranging from 1 mo to 18 y (mean age 8 y) were included in the study. The indications for remdesivir were 4 children with moderate COVID-19 pneumonia (age related tachypnea with/without hypoxia), 4 children with computerized tomographic (CT) but no clinical evidence of pneumonia, 2 ventilated infants with nosocomial COVID-19 infection following post complex cardiac surgery and 11 children with mild COVID-19 infection with risk factors including post hematologic stem cell transplant recipients (n = 5), hematologic malignancy on chemotherapy (n = 5) and neonate with congenital heart disease (n = 1).

All children received the full course except two where therapy was interrupted due to transient elevation of liver enzymes/early discharge (1 each). No cases of sinus bradycardia were observed. Two patients with COVID-19 pneumonia and hypoxia also received steroids. Nineteen children improved and were discharged. Two infants with COVID-19 infection following congenital heart surgery died but causal relationship with COVID-19 could not be established.

Our study adds to growing evidence of safety and tolerability of remdesivir in infants and children with COVID-19 [2,3,4]. However in the absence of a control group no conclusions about efficacy can be made.