Table 2.
Comparison of guidelines and unified guideline for the management of multisystem inflammatory syndrome in children [1–10]
| Variables | AAP | ACR | HDVCH | CHKD | IDSA | Unified |
|---|---|---|---|---|---|---|
| Similarities | IVIG (1–2 g/kg) | IVIG (1–2 g/kg) | IVIG (1–2 g/kg) | IVIG (1–2 g/kg) | IVIG (1–2 g/kg) | IVIG (1–2 g/kg) |
|
Steroid therapy (methylprednisolone 2–30 mg/kg/d) |
Steroid therapy (glucocorticoids low-moderate dose, and high dose of patients with life-threatening complications) | Steroid therapy (methylprednisolone 1–2 mg/kg/d administrated as IV/PO, over 2–4 wk) | Steroid therapy 2 mg/kg | Steroid therapy (corticosteroids) | Steroid therapy (2–3 mg/kg/d) | |
| Antiplatelet therapy (aspirin low-dose) |
Antiplatelet therapy (aspirin low dose, 3–5 mg/kg/d; max 81 mg/d, avoided in patients with a platelet count ≤ 80,000/μL) Patients with a Z score ≥ 10.0 treated with low dose aspirin and anticoagulation with enoxaparin or warfarin |
Antiplatelet therapy (aspirin 3–5 mg/kg/d, max = 81 mg orally) | Antiplatelet therapy (aspirin low dose) | Antiplatelet therapy (aspirin) | Antiplatelet therapy (aspirin low-dose) | |
| No antiviral | No antiviral | No antiviral | No antiviral | Antiviral | Antiviral: remdesivir 5 mg/kg load IV once (max dose 200 mg) on day 1, then 2.5 mg/kg (100 mg max dose) IV daily for 9 d | |
| Differences | Antibiotic therapy | No antibiotics | No antibiotics | No antibiotics | No antibiotics | Antibiotic therapy: (1) mild illness: ceftriaxone. If gastrointestinal symptoms are predominant add metronidazole; (2) severe illness or shock: vancomycin, clindamycin, and cefepime or vancomycin, meropenem, and gentamicin |
| Anticoagulant therapy (enoxaparin in patients with thrombosis) | Anticoagulant therapy (enoxaparin in patients with thrombosis or an ejection fraction < 35% should receive until at least 2 wk after discharge from the hospital) | Anticoagulant therapy: (1) enoxaparin, prophylaxis dosing, < 2 mon: 0.75 mg/kg/dose q12 h, ≥ 2 mon: 0.5 mg/kg/dose q12 h; (2) enoxaparin, therapeutic dosing, < 2 mon: 1.5 mg/kg/dose q12 h, ≥ 2 mon: 1 mg/kg/dose q12 h | No anticoagulant therapy | No anticoagulant therapy |
Anticoagulant therapy (enoxaparin; prophylaxis/ therapeutic) |
AAP American Academy of Pediatrics, ACR American College of Rheumatology, HDVCH Helen DeVos Children's Hospital Foundation, CHKD Children’s Hospital of The King’s Daughters, IDSA Infectious Diseases Society of America, IVIG intravenous immune globulin, PO oral