Respiratory infectious diseases are one of the most common diseases in children, mainly caused by viral and bacterial infections, and viral infections account for more than 70%. The main purpose of the "Guidelines for the Rational Application of Antiviral Drugs in Children's Viral Infectious Respiratory Diseases" is to provide a reference for pediatricians at all levels to standardize the use of antiviral drugs in children's Viral Infectious Respiratory Diseases. Regarding the application of broad-spectrum antiviral drugs in viral infectious respiratory diseases in children, the guidelines mainly involve the following contents.
Interferon α(IFNα)
IFN is a class of proteins with broad-spectrum antiviral activity, with antiviral and immune regulation effects, and is divided into type I, type II and type III. Among them, type IFN (mainly IFNα/β) plays an important role in inhibiting viral infection.
viruses mostly proliferate rapidly in respiratory mucosal epithelial cells, causing local respiratory infections or tissue lesions outside the respiratory tract. IFNα is often used in clinical practice for local treatment through spraying or atomization inhalation, which helps to remove the virus, shorten the course of the disease, reduce symptoms, and is safe.
IFNα can be used for acute upper and lower respiratory tract infections in children caused by viral infection, herpes pharyngeal inflammation and hand, foot and mouth disease. In addition, IFNα spray or atomization has also been tried for antiviral treatment of COVID-19. The recommended usage and dosage are as follows.
1. IFNα spray
can be used to closely contact susceptible people who are infected with viruses or early stages of viral infection.
(1) Acute upper respiratory tract infection: 1 to 2 sprays per side of the nasal cavity and 8 to 10 sprays in the oropharynx. Each spray contains 8 to 10 international units (IU), and the drug is given once every 1 to 2 hours, 8 to 10 times/d, and 800,000 IU/d. The recommended course of treatment is 5 to 7 days; the usage of high-risk people who are exposed to suspected 2019-nCoV infection or those who are present with upper respiratory tract symptoms in the early stage of viral infection are the same as above.
(2) Hand, foot and mouth disease, herpetic pharyngeal inflammation: spray it on the oral lesions, pharynx, bilateral tonsils and skin affected areas of the child to cover the entire wound. It is advisable to give it once every 1 to 2 hours, 1 million IU/d, and the dose can be doubled on the first day. It is recommended to have a course of treatment of 3 to 7 days.
2. IFNα atomization inhalation
can be used for acute lower respiratory tract infection in children caused by viral infection.
(1) Normal type: IFNα2b 100,000 to 200,000 IU/kg or IFNα1b 1 to 2 μg/kg 2 times/d. The recommended course of treatment is 5 to 7 days. In order to ensure that the effective ingredients of the drug can reach the small airway and lungs, the diameter of the effective atomized particles needs to reach 0.5 to 10.0 μm (3.0 to 5.0 μm is preferred). The atomization device should use a jet atomizer (also known as a jet atomizer and a compressed gas atomizer). Ultrasonic atomizer and vibrating screen hole atomizer should not be used, as the latter two will destroy the stability of the interferon structure.
(2) Heavy: IFNα2b is 200,000 to 400,000 IU/kg or IFNα1b 2 to 4 μg/kg, 2 times/d, and the recommended course of treatment is 5 to 7 days.
3. IFNα intramuscular or subcutaneous injection
In medical institutions without atomization conditions, children with bronchiolitis or viral pneumonia can choose IFNα intramuscular or subcutaneous injection at their discretion. Usage and dosage: 100,000 to 200,000 IU/kg each time or 1 to 2 μg/kg each time, 1/d, and the recommended course of treatment is 5 to 7 days.
4. Precautions
IFNα spray or atomization treatment generally has no obvious adverse reactions and is safer. Intramuscular injectors with IFNα may have flu-like symptoms in the early stage. For those with long-term injection treatment, they may have adverse reactions such as myelosuppression and mental abnormalities. It is recommended to have regular follow-up examinations.
Publication of liver function, people with a history of mental illness, symptomatic heart disease, and children with aplastic anemia are prohibited. There are currently no clinical research reports on aerosolized inhalation of IFNα in neonates and children under 2 months of age, and it is recommended to use it with caution.
ribavirin (Ribavirin)
ribavirin is a synthetic nucleoside broad-spectrum antiviral drug that can compete to inhibit viral syntheses and synthesis of viral RNA and proteins. It has the effect of inhibiting RSV, IV, PIV and other viruses. The main adverse reactions after intravenous or oral administration are hemolytic anemia , hemoglobin reduction and anemia, liver function impairment, fatigue, etc.
World Health Organization (WHO), the U.S. Food and Drug Administration (FDA) and my country's NMPA have all given key safety warnings on the reproductive toxicity and hemolytic anemia of ribavirin. Given that ribavirin has a large and serious adverse reactions, it is not routinely recommended to treat viral infectious respiratory diseases in children.
For children with severe hand, foot and mouth disease, they can be used with caution after weighing the pros and cons. Ribavirin: 10-15 mg/(kg·d), divided into 2 intravenous drips, and the course of treatment is 3-5 days. Pay close attention to its adverse reactions and reproductive toxicity during use.
The above content is excerpted from: Chinese Hospital Association , National Children's Medical Center (Beijing), National Medical Center for Infectious Diseases, etc. Guidelines for the rational application of antiviral drugs in children with viral infectious respiratory diseases [J]. Chinese Journal of Practical Pediatrics Clinical, 2020, 35(19): 1441-1450.
