ARVI, as you know, make up the majority of cases of visiting doctors during the cold season, and the pandemic of the new coronavirus infection only aggravates the situation. Infection most often occurs by airborne droplets. Viruses enter the body through the nasopharynx, which is why it is often called the “gate” of infection. Pathogens scattered in the environment, when inhaling air, settle on the mucous membrane of the nasal cavity, and it is there that they are introduced into the body, as a result of which respiratory diseases can develop. That is why it is important to prevent direct contact of viruses with the mucous membrane and their subsequent penetration into the respiratory tract. By resorting to antiviral agents that are applied directly to the mucous membrane of the nasal passages, we prevent their reproduction and further spread of the virus.
- How to choose an ointment for a child
- Mechanism of transmission of ARVI
- Colds in childhood
- Nasal antiviral for children
- Adults taking antiviral drugs into the nose (intranasally)
- Viferon Gel
- Viferon ointment
- Application diagram
- The mechanism of immunity
What is Oxolinic ointment?
This is a pasty viscous substance based on oxoline. The ointment has a yellow tint, a homogeneous, slightly oily structure. Plastic, easily distributed over surfaces. After long-term storage, the product sometimes becomes pinkish or bluish. This feature does not affect its properties.
The medicine is released in different concentrations:
- with oxoline content 0.25%: in tubes of 10 g, used for the treatment of mucous membranes;
- with an active ingredient content of 3%: packaged in tubes of 10–30 g, suitable for treating skin or eliminating intense pathological processes.
Auxiliary compounds of the drug: wax, paraffin, vaseline oil.
Modern drugs for the treatment of ARVI and influenza
Acute respiratory infections (ARVI) are the most common among all infectious diseases. ARVI and influenza account for at least 70% of infectious diseases. In Russia, about 50 million infectious diseases are registered annually, of which up to 90% of cases are ARVI and influenza.
Almost 90% of the population experience one of the respiratory infections of viral etiology at least once a year, which generally determines high morbidity and even affects the mortality rate [2].
Such a high incidence of respiratory tract diseases is explained by a variety of etiological factors (influenza viruses, parainfluenza, adenoviruses, rhinoviruses, reoviruses, respiratory syncytial (RS) viruses, mycoplasmas, chlamydia, bacterial agents), as well as the ease of transmission of the pathogen and the high variability of viruses.
Differential diagnosis of influenza and ARVI is difficult due to the similarity of the clinical picture of these diseases, but it is quite possible. The main differences can be considered the initial signs of the disease, symptoms of intoxication, the nature of catarrhal symptoms and fever, the type of complications that develop, etc. The clinical diagnosis, confirmed by laboratory tests, determines the choice of therapy.
The clinical picture of ARVI and influenza depends on the causative virus (see table).
It should be noted that complications from ARVI, especially during an epidemic, are recorded in 20–30% of cases. The main causes of complications are disorders of the immune defense, leading to long-term insufficiency in the functioning of the immune system. A decrease in the body's antibacterial resistance leads to protracted periods of convalescence and creates the possibility of complications over a long period of time. A special place among complications is occupied by the so-called post-viral asthenia syndrome (PAS), which can develop in 65% of patients within 1 month from the onset of the disease. The leading symptoms of SPA are fatigue, emotional disturbances and various mental disorders.
The range of drugs used in the treatment of ARVI and influenza is wide and varied. It includes live and inactivated vaccines, chemotherapy drugs with etiotropic action, as well as drugs used for immunocorrective and pathogenetic therapy.
However, the course of influenza and other acute respiratory viral infections remains difficult to control. This is due not only to the polyetiology of these diseases, but also to the unique variability of viruses and the global nature of epidemics. The spread of ARVI largely depends on the environmental, socio-economic situation, the presence of allergic diseases in patients and a number of other factors.
Antiviral drugs
Chemotherapy
The mechanism of action of this group of drugs is based on the selective suppression of individual stages of viral reproduction, without interfering with the vital activity of the cell of the macroorganism. For respiratory infections, two groups of drugs are used - M2 channel blockers and neuroaminidase inhibitors, as well as ribavirin, which is active against the RS virus.
M2 channel blockers
In 1961, a symmetrical amine, amantadine, was synthesized, and then a number of its derivatives (rimantadine, midantan, deutiforin). In our country, rimantadine is widely used, which is used for the treatment and prevention of influenza caused by the type A virus. The effectiveness of this drug is 70–90%.
The antiviral effect is realized by blocking special ion channels (M2) of the virus, which is accompanied by a violation of its ability to penetrate cells and release ribonucleoprotein. This inhibits the most important stage of viral replication. In approximately 30% of cases, resistance to rimantadine may develop [6].
Rimantadine is available in the form of rimantadine in tablets of 50 mg and syrup for children from 1 to 7 years of age - algirem - 2 mg/ml. For therapeutic purposes, the drug is prescribed from the moment the first symptoms are registered. The duration of therapy should not exceed 5 days to avoid the emergence of resistant forms of the virus. As a preventative measure, rimantadine should be taken for at least 2 weeks.
Neuroamindase inhibitors
Drugs in this group are effective not only against type A influenza viruses, but also against type B viruses.
Neuroamindase (sialidase) is one of the key enzymes involved in the replication of influenza viruses. When neuroamindase is inhibited, the ability of viruses to penetrate healthy cells is impaired, their resistance to the protective effect of respiratory tract secretions is reduced, and thus the further spread of the virus in the body is inhibited. Neuroamindase inhibitors are able to reduce the production of cytokines (IL-1 and tumor necrosis factor), preventing the development of a local inflammatory reaction and weakening systemic manifestations of a viral infection such as fever, pain in muscles and joints, and loss of appetite [7].
Preliminary studies have shown that the effectiveness of such an inhibitor as a prophylactic agent is 70–80%. Taking these drugs can reduce the duration of the disease by 1–1.5 days (if you start taking the drug no later than 36–48 hours from the moment the first symptoms appear). At the onset of the disease and in its early stages, the average duration of viral replication is reduced by an average of 3 days, and the number of severe forms of ARVI and influenza, characterized by elevated temperature, by 85%. The drugs do not have a harmful effect on the central nervous system. However, it should be noted that it is not always possible to use them in the first 48 hours: due to the difficulties associated with the differential diagnosis of influenza and other acute respiratory viral infections.
Representatives of neuroamindase inhibitors are oseltamivir and zanamivir.
Oseltamivir (Tamiflu) is prescribed 75–150 mg 2 times a day for 5 days. For prevention - 75 mg 1 or 2 times a day for 4–6 weeks. In patients with creatinine clearance less than 30 ml/min, the dose is reduced by 2 times.
Zanamivir (Relenza) is a structural analogue of sialic acid, a natural substrate of influenza virus neuroamidase, and therefore has the ability to compete with it for binding to the active site. It is inhaled using a special device - a diskhaler. For therapeutic purposes, 10 mg is prescribed 2 times a day (with an interval of 12 hours) for 5 days, for prevention - 10 mg 1 time a day for 4-6 weeks. The inhalation route of administration has the advantage of providing a fairly rapid antiviral effect in the area of the primary source of infection.
Adverse reactions of this group of drugs account for no more than 1.5% of cases. Most often these are headache, dizziness, nausea, diarrhea, and sinusitis. Patients with obstructive bronchopulmonary diseases may develop bronchospasm.
Drugs active against other viruses
Ribavirin (virazol, rebetol), which acts on many RNA and DNA viruses, is used in aerosol dosage form to treat infections caused by the RS virus. It is assumed that the drug inhibits the early stages of viral transcription, disrupting the synthesis of ribonucleoproteins, messenger RNA, and blocking RNA polymerase. It is used inhalation using a nebulizer only in a hospital setting.
When taking ribavirin, bronchospasm, rash, and eye irritation may occur, not only in patients, but also in medical staff. In rare cases, leukopenia, insomnia, and irritability are observed. There is a risk of drug crystallization in the respiratory tract and endotracheal tubes. Has a teratogenic effect.
A promising antiviral drug is plenoconaril, recently developed in the USA. In vitro studies and animal experiments have revealed its activity against enteroviruses and rhinoviruses. Data from the first placebo-controlled studies indicate the effectiveness of the drug against respiratory infections and enteroviral meningitis [8].
In Russia, original antiviral drugs are used, created on the basis of domestic developments. The most widely known of them is arbidol. It has an inhibitory effect on influenza viruses type A and B and other respiratory viruses, the mechanism of which is not fully understood. It is believed that such an effect is associated with both the interferon-inducing and immunomodulatory properties of the drug. In particular, arbidol stimulates the activity of phagocytic cells. Available in tablets of 0.1 g. For medicinal purposes, 0.2 g is prescribed 3-4 times a day for 3-5 days. For prophylactic purposes, 0.2 g/day is used for 10–14 days.
Interferons
Interferons (IFNs) are among the regulators of immunogenesis. They are produced by various cells and not only implement the antiviral response, but also regulate immunological reactions. The main effects of interferons can be divided into antiviral, antimicrobial, antiproliferative, immunomodulatory and radioprotective.
Despite the diversity of the genetic material of viruses, IFNs suppress their reproduction at a stage required for all viruses: they block the onset of translation, i.e., the synthesis of virus-specific proteins. This may explain the universality of the antiviral action of interferon. Under the influence of interferon in the body, the activity of natural killer cells, T-helper cells, cytotoxic T-lymphocytes, phagocytic activity, the intensity of B-lymphocyte differentiation, and the expression of MHC type I and II antigens increases [1].
α- and β-interferons are used to treat viral infections. A good effect in treatment is achieved by the combined use of chemotherapy and IFN drugs.
β-interferon (betaferon) is available in powder form, in bottles containing 9.5 million units of IFN. For influenza, it is instilled or sprayed into the nasal passages at least 4–5 times a day [2].
Human leukocyte interferon is a mixture of interferons synthesized by leukocytes of donor blood in response to exposure to a viral inducer. The drug is administered by inhalation or an aqueous solution prepared from a dry substance in an ampoule or bottle is instilled into the nasal passages.
Viferon - recombinant interferon-α 2b - is available in the form of rectal suppositories and is used in the treatment of acute respiratory viral infections and influenza. Damage to cell membranes observed during the development of the infectious process is the reason for the decrease in the antiviral activity of interferon. Tocopherol acetate and ascorbic acid, which are part of Viferon, are membrane-stabilizing components, antioxidants, in combination with which the antiviral activity of recombinant interferon-α 2b increases 10–14 times [1].
The peculiarities of the administration of the dosage form ensure long-term circulation of interferon-α 2b in the blood.
The drug is used both in newborns and in adult patients with ARVI and influenza in age-specific dosages. Children under 7 years of age are prescribed Viferon-1, children over 7 years of age and adults - Viferon-2.
Interferon inducers
Exogenous interferon preparations are logically combined with the use of its inducers in clinical practice. They represent a very heterogeneous family of high- and low-molecular natural and synthetic compounds, united by the ability to induce in the body the formation of its own (endogenous) interferon α- and β-interferons in different proportions by leukocytes, macrophages, epithelial cells, as well as tissues of the spleen and liver , lungs, brain. The drugs penetrate the cytoplasm and nuclear structures and activate the synthesis of “early” interferons. Helps correct the immune status of the body [3].
Amiksin is a low molecular weight synthetic inducer of endogenous aromatic interferon, belonging to the class of fluorenones. The main structures that produce interferon in response to the administration of amixin are intestinal epithelial cells, hepatocytes, T-lymphocytes, and granulocytes. In human leukocytes, amixin induces the formation of interferon, the level of which in the blood is 250 U/ml. After taking amixin orally, the maximum interferon in humans is determined sequentially in the intestines, liver, and blood after 4–24 hours [2].
When treating influenza and acute respiratory viral infections, amixin is prescribed in the first hours of the disease; 5–6 tablets are enough per course. For the purpose of prevention, it is prescribed once a week for 4–6 weeks.
Cycloferon is a low-molecular-weight inducer of IFN-α, which determines a wide range of its biological activity. It quickly penetrates cells, accumulating in the nucleus and cytoplasm. Cycloferon intercalates cell DNA, which is responsible for the mechanism of its interferon-inducing activity [3].
Cycloferon quickly penetrates the blood. There is low binding to blood proteins and at the same time widespread distribution in various organs, tissues, and biological fluids of the body.
Due to the fact that cycloferon is a low-molecular drug, it easily crosses the blood-brain barrier, causing the formation of IFN in the brain. Cycloferon is quickly eliminated from the body: 99% of the administered drug is eliminated unchanged by the kidneys within 24 hours.
Cycloferon is well tolerated by patients and is prescribed from the first day from the onset of the disease in tablet form or parenterally [4].
Ridostin is a high molecular weight IFN inducer of natural origin. Ridostin is a double-stranded RNA obtained from the lysate of the killer yeast Saccharamyces cervisiae.
Systemic administration of ridostin stimulates the production of early IFN. The maximum accumulation of IFN in serum is observed 6–8 hours after injection; after 24 hours it is not detected in the bloodstream [1].
The drug exhibits a pronounced immunomodulatory effect. It stimulates T-cell and humoral immunity, proliferation of bone marrow stem cells and phagocytic activity of macrophages and neutrophils in peripheral blood. Ridostin increases the level of corticosteroid hormones; used for the treatment and prevention of influenza and other acute respiratory viral infections.
Currently, the drug dibazol, used for the treatment and prevention of influenza and ARVI, is undeservedly forgotten. Dibazol has immunomodulatory activity and induces the production of endogenous interferon. For prevention, 1 tablet (0.02–0.05 g) is prescribed once a day for 3–4 weeks; for treatment, 1 tablet 3 times a day for 5 days.
Indispensable in the treatment of influenza and ARVI are complex drugs such as Grippostad, Rinza, Theraflu, Fervex, as well as drugs for external and local use - Doctor Mom cold ointment, Tussamag cold balm.
Despite the variety of drugs presented for the treatment of acute respiratory viral infections and influenza at the present stage, the choice of a drug remains an urgent task for the practicing physician. The choice of tactics for prescribing and managing a patient with ARVI or influenza is directly related to the severity of the infectious process, the form of the disease and the presence of complications. The success of treatment depends on the correct assessment of the patient’s condition and early initiation of treatment.
O. A. Melnikov , Candidate of Medical Sciences L. V. Averkieva “GUTA-Clinic”, Moscow
How does Oxolinic ointment work?
The drug disrupts the integrity of the cell membranes of pathogens, causing their death. When applied to the surface of the skin and mucous membranes, the ointment mechanically prevents their infection, softens, and reduces the symptoms of inflammation. Oxolin affects pathogens of influenza, molluscum contagiosum, herpes simplex, adenoviruses, and rhinoviruses.
The use of ointment does not lead to a systemic effect on the body. The amount of oxoline that penetrates through the capillaries into the blood is insignificant. The product does not accumulate in tissues and has no cumulative effect. Particles that get inside are completely metabolized.
Routes of transmission of acute respiratory infections to adults and children
The prevalence of ARVI is associated both with a variety of pathogens and with the fact that specific immunity against past infections does not persist for a long period of time. Pathogens are easily transmitted in the environment. The need to be in a common space with other people (public transport, preschool and educational institutions, etc.) increases the risk of infection. In some cases, the carrier of the infection, without even knowing about his danger to others, can transmit the virus several days before the manifestation of clinical symptoms. The maximum danger of infection usually occurs 1-3 days from the onset of the disease. The minimum social distance, which is often recalled during the coronavirus pandemic, is 1.5 - 2 meters, but this distance, unfortunately, does not take into account factors such as air turbulence, the speed at which particles are released when coughing and sneezing.
When to use Oxolinic ointment
Traditionally, the medicine is used during respiratory epidemics and when communicating with possible carriers of influenza viruses. The list of indications for use of the drug includes:
- influenza and other respiratory viral pathologies;
- blepharitis;
- inflammation of the conjunctiva;
- lichen lesions;
- molluscum contagiosum;
- dermatitis;
- herpes stomatitis;
- skin warts of viral origin.
The use of medicine for preventive purposes and at an early stage of pathologies is more effective than for advanced infections. To achieve a pronounced therapeutic effect, this drug must be combined with other drugs.
Colds in childhood
Children easily exchange infections by contacting each other. Only the first months of life are relatively safe, when the child retains the passive immunity received from the mother. The baby is somewhat isolated: contact is often limited to family members. Unfortunately, the possibility of infection cannot be completely excluded even in infancy. Among preschoolers under five years of age, the highest incidence is observed, which is obviously associated with increased social contacts and visits to children's groups. “Sadovsky” children can get ARVI up to 10-15 times during the first year, then the frequency decreases by about half, but in subsequent years it remains quite high - 3-5 times a year. Repeated colds can deplete a child’s body, reduce defenses, delay normal development, contribute to the formation of “smoldering” foci of infection and allergies, and interfere with preventive vaccinations. Specific methods of prevention include vaccination. However, the vaccine works against a specific pathogen, for example, the influenza virus, but does not work against other infections, of which there are several hundred, as we know. Non-specific methods include hardening and the use of antiviral drugs according to the scheme proposed by your pediatrician.
Side effects of the ointment
When first applied, a slight burning sensation, increased runny nose, and irritation of the integument are likely to occur. With prolonged daily use, the nasal mucosa may feel dry. The risk of drying out is especially high during simultaneous treatment with vasoconstrictor drops. With proper use of the product, the discomfort gradually goes away on its own. If symptoms increase over time, the ointment should be discarded, as an allergic reaction is possible.
Oxolinic ointment does not affect the speed of psychomotor reactions and the activity of the central nervous system; it is allowed when driving vehicles and operating complex equipment.
Mechanism of action of immunity in the nose
Most infectious agents enter the body from the surface of the mucous membranes, which are the initial portal of entry for most respiratory viruses. The immune system uses various mechanisms to fight infections. – In addition to increasing the activity of general systemic immunity, local immunity plays an important role in protecting against pathogenic viruses. It is this that helps to cope with those pathogens that have settled on the surface of the mucous membranes of the nasopharynx and prevents the further spread of infection inside.
Secretory A-type immunoglobulins are special protein substances - they play a major role in the prevention of disease or recovery. Specific prevention of viral infections involves the immune system of the mucous membranes. The IgA present on them, the action of which is aimed at neutralizing the infection, can come from blood serum or be secreted by cells of submucosal tissue.
An effective measure to protect the upper respiratory tract is the induction of immunoglobulins precisely at the sites of virus replication - the nasopharynx. Stimulating the production of high titer whey proteins is more effective for the lower respiratory tract.
Strengthening the activity of local immunity plays an important role in preventing infection of the body by certain viruses, especially influenza. Knowledge of the mechanism of formation of local immunity makes the search for means that provide protection of mucous membranes from infectious agents a solvable task. Thus, at the beginning of the last century, the theory of local immunity was formulated, and subsequently data was accumulated indicating the important role of local protective factors in a number of viral infections. With the discovery of immunoglobulin A and evidence of its secretion by mucosal cells, a new era in the development of applied immunology began.
In particular, it was found that IgA is the most important immunoglobulin, the main biological function of which is to protect the mucous membranes from infectious agents. The most likely mechanism of IgA neutralization of the virus is to prevent the virus from binding to target mucosal cells, although others are possible.
It was found that IgA can not only prevent the virus from attaching to cellular receptors, but also inhibit its penetration into the cell or replication. Studies of the mechanism of intracellular neutralization of the virus allow us to conclude that IgA can contribute not only to protection against viral infection of the mucous membranes, but also to its terminationii.
The drug VIFERON Gel, for example, has a pronounced local immunomodulatory effect and helps to increase locally formed antibodies of the secretory IgA class, which prevent the fixation and proliferation of pathogenic microorganisms on the mucous membranes, which provides a preventive effect of the drug for the prevention of viral and other diseases.
