Table 4.

Summary and quality of the evidence and recommendations on the pharmacological treatment of COVID-19.

Quality of evidence	Summary of evidence	Recommendations
Hydroxychloroquine
Low	There is low-quality indirect evidence that hydroxychloroquine is not effective for treatment of COVID-19.	Strong against	The use of hydroxychloroquine and chloroquine in paediatric patients with COVID-19 is not recommended.
Steroid therapy
Moderate	There is indirect evidence of moderate quality and, when it comes to some measures, low quality due to imprecision or inconsistency, that steroids can achieve a reduction in mortality and the need of mechanical ventilation.	Weak in support	Contemplate use of steroids in paediatric patients with COVID-19 and respiratory compromise.
Tocilizumab
Moderate	There is indirect evidence of moderate quality that tocilizumab does not reduce mortality and of low quality that it does not have an impact on composite measures of severity (mechanical and/or non-invasive ventilation).	Weak against	Use of tocilizumab is not recommended in paediatric patients with COVID-19.
Hyperimmune plasma and immunoglobulin therapy
Low	There is indirect evidence of low quality that hyperimmune plasma does not reduce mortality and of very low quality that it does not decrease the duration of survival. There is no experimental evidence on the efficacy of immunoglobulin therapy.	Weak against	Use of hyperimmune plasma is not recommended in paediatric patients with COVID-19.
Multisystemic inflammatory syndrome in children associated with SARS-CoV-2 infection
Very low	There is no evidence on the efficacy of different treatments used for management of patients with MIS-C associated with SARS-CoV-2 infection. Observational studies suggests that the combination of intravenous immunoglobulin and methylprednisolone may be more effective than the isolated use of intravenous immunoglobulin.	Weak in support	Contemplate use of intravenous immunoglobulin combined with methylprednisolone for treatment of MIS-C associated with infection by SARS-CoV-2.
Other drugs
Very low	There is indirect evidence of very low quality, due to methodological limitations or lack of precision, that does not support the efficacy of other treatments under study. Favourable outcomes have only been observed with remdesivir and calcifediol. The evidence remdesivir is unclear and hints at a possible reduction in mortality but not in the need of mechanical ventilation. Further research should be conducted on the use of calcifediol before making general recommendations for its use in clinical practice.		There is no evidence to support recommendations regarding the use of remdesivir or calcifediol in patients with COVID-19.
		Weak in support	Use of other drugs is not recommended: ritonavir/lopinavir, favipiravir, umifenovir, alpha-lipoic acid, baloxavir marboxil, bavirin, interferon alpha, ruxolitinib, colchicine, febuxostat, marboxil, azvudine, leflunomide, ribavirin.

MIS-C, multisystemic inflammatory syndrome in children associated with SARS-CoV-2.