Pediatric Nirmatrelvir/Ritonavir Prescribing Patterns During the COVID-19 Pandemic

OBJECTIVES This study seeks to identify demographic and clinical factors prompting clinician prescribing of nirmatrelvir/ritonavir to pediatric patients for management of coronavirus disease 2019 (COVID-19) infection. METHODS Patients aged 12 to 17 years with a COVID-19 infection and nirmatrelvir/ritonavir prescription during an outpatient clinical encounter within a PEDSnet-affiliated institution between January 2022 and August 2023 were identified using electronic health record data. A multivariate logistic regression analysis was used to estimate odds of nirmatrelvir/ritonavir prescription after adjusting for various factors. RESULTS A total of 20 959 patients aged 12 to 17 years were diagnosed with a COVID-19 infection on the basis of an electronic health record-documented positive polymerase chain reaction or antigen test or diagnosis during an outpatient clinical visit. Of these patients, 408 received a nirmatrelvir/ritonavir prescription within 5 days of diagnosis. Higher odds of nirmatrelvir/ritonavir treatment were associated with having chronic or complex chronic disease (chronic: odds ratio OR 2.50 95% confidence interval (CI) 1.83–3.38; complex chronic: OR 2.21 95% CI 1.58–3.08). Among patients with chronic disease, each additional body system conferred 1.18 times higher odds of treatment (95% CI 1.10–1.26). Compared with non-Hispanic white patients, Hispanic patients (OR 0.61 95% CI 0.44–0.83) had lower odds of treatment. CONCLUSIONS Children with chronic conditions are more likely than those without to receive nirmatrelvir/ritonavir prescriptions. However, nirmatrelvir/ritonavir prescribing to children with chronic conditions remains infrequent. Pediatric data concerning nirmatrelvir/ritonavir safety and effectiveness in preventing severe disease and hospitalization are critical optimizing clinical decision-making and use among children.