A summary of the usage of 10 antiviral drugs for children, just read this one

Only for medical professionals to read for reference, experts teach you the rational use of drugs! In pediatric diseases, viral infections are very common.
The pathogens of common colds, flu, diarrhea, hand-foot-mouth disease and other diseases may all be viruses.
Viral pneumonia also accounts for a large proportion of childhood pneumonia
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However, there are not many effective antiviral drugs that can act on children in China, and there are still many problems of irregular use
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A few days ago, at the 26th National Pediatric Academic Conference of the Chinese Medical Association, Professor Shu Sainan from the Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology gave a wonderful explanation on the rational use of antiviral drugs for children.
Come and learn together Come on! Which viruses should pediatricians focus on? As a tiny pathogen that parasitizes the human body, viruses endanger people's lives and health.
Understanding the virus allows us to better overcome it or use it
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So what should pediatricians focus on clinically? Adenovirus can be said to be the most familiar to pediatricians.
Many pediatricians are troubled by severe adenovirus pneumonia; Norovirus in the calicivirus family, with the gradual development of rotavirus vaccination, norovirus may It will gradually replace rotavirus and become the number one pathogen; the coronavirus family is now familiar to everyone
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The world is facing a new type of coronavirus pneumonia.
The previous SARS viruses belong to the coronavirus family and are very harmful; influenza viruses in the filoviridae, herpesviruses, and orthomyxoviridae, and measles viruses and parotid glands in the paramyxoviridae Inflammatory viruses and parainfluenza viruses are also something that pediatricians need to pay attention to; rotavirus, rubella virus, parvovirus B19, Boca virus (respiratory virus), enterovirus, etc.
also cause great harm and need to be paid attention to
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Here are some common antiviral drugs and how they should be used clinically
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01 Ribavirin Ribavirin was a class of antiviral drugs commonly used by pediatricians in the past.
It is a guanine nucleotide analog.
The main function of metabolites is to interfere with the capping and extension of viral mRNA
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Main functions: broad-spectrum antiviral agents are effective against RNA viruses and DNA viruses, including paramyxovirus, paramyxoviruses, bunyaviruses, herpes viruses, adenoviruses and the like
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Among them, it is more effective against RNA viruses
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Route of administration: oral, intravenous injection, atomized inhalation (mainly oral and intravenous injection in China)
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Treatment direction: US FDA approved ribavirin for respiratory syncytial virus (RSV) infection, combined with interferon to treat hepatitis C virus infection; Lassa fever (Lassa virus), epidemic hemorrhagic fever (Hantaan) Virus) and other hemorrhagic fever: treatment and prevention; adenovirus pneumonia: early application may shorten the course of the disease and relieve symptoms; early hand, foot and mouth disease: use of ribavirin intravenous drip has a certain effect; new Bunia virus : Ribavirin has a certain inhibitory effect and can be used clinically for patients with fever and thrombocytopenia syndrome
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Adverse reactions: Anemia: Oral or intravenous ribavirin can cause measurement-related reversible anemia (low-dose anemia is caused by extravascular hemolysis, and high-dose anemia is caused by bone marrow suppression)
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Teratogenicity: Women of childbearing age have potential teratogenicity; but in primate experimental models, when the dose is as high as 120mg/kg, no adverse effects on the fetus have been observed
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Other adverse reactions: From 1986 to 1988, 127,000 infants used ribavirin with good overall safety; reported side effects include nausea, headache, and rare exacerbation of bronchospasm; skin rash, conjunctivitis, and ribavirin use It's related, but it usually subsides within a few hours after stopping the drug
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Therefore, Professor Shu Sainan pointed out that clinicians should judge whether to use ribavirin according to the specific condition
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02 Ganciclovir Ganciclovir is also an antiviral drug commonly used by pediatricians.
It is a nucleoside analogue that interferes with the viral DNA polymerase mainly through ganciclovir triphosphate formed after phosphorylation in the body
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Treatment direction: Cytomegalovirus infection
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Life-threatening and vision-affecting CMV infections occur in immunosuppressed (immune-compromised) patients
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25% of ganciclovir recipients will develop resistance 9 months after the start of treatment, at which time they can be combined with other drugs (such as foscarnet)
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Severe CMV-related diseases in children include CMV hepatitis, CMV pneumonia, and CMV encephalitis
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New progress: Ganciclovir has been evaluated for the treatment of newborns and infants with congenital CMV infection
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Tests have shown that ganciclovir treatment (6 mg/kg intravenously for 6 hours per dose for 6 weeks) can protect infants from hearing deterioration and improve neurological outcomes
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Toxic and side effects: bone marrow suppression: 40% of treated patients developed neutropenia within two weeks, 20% of treated patients developed thrombocytopenia, and 2% of treated patients developed anemia (but it is reversible after stopping the medication)
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Note: Granulocyte colony stimulating factor can be used to prevent or treat neutropenia
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03 Valganciclovir Valganciclovir is the prodrug of ganciclovir.
Oral use can achieve antiviral effects similar to ganciclovir, but the toxic side effects of valganciclovir are better than ganciclovir.
Wei Qing
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Oral valganciclovir 16mg/kg is equivalent to 6mg/kg intravenous ganciclovir
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Treatment direction: children with congenital cytomegalovirus infection and symptoms, use valganciclovir as a long-term treatment in the later stage of antiviral therapy
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Infants with symptomatic congenital CMV disease can improve their hearing and neurodevelopmental outcomes
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Side effects: diarrhea, nausea, neutropenia, anemia and headache
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Compared with intravenous ganciclovir, neutropenia is relatively rare during oral valganciclovir treatment
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04Acyclovir/Valacyclovir/Penciclovir can be classified as a class of drugs because their mechanism of action is actually similar to acyclovir in the end
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Acyclovir is monophosphorylated by the virus-encoded thymidine kinase (TK) (if the acting virus does not have TK, the antiviral effect of acyclovir will be greatly reduced), and then the host cell enzyme catalyzes the diphosphorylation, three Phosphorylated, acyclovir triphosphate prevents viral DNA synthesis by inhibiting viral DNA polymerase
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Treatment direction: Good antiviral effect on herpes simplex virus (HSV) and varicella-zoster virus (VZV) encoded by thymidine kinase
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Epstein-Barr virus (EBV) DNA is easily controlled by acyclovir triphosphate, so although EBV has only a small TK activity, it has a moderate sensitivity to acyclovir
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05 Adenosine arabinosine is a derivative of purine nucleotides, and it is used more clinically, especially in grassroots units
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The triphosphate derivative of arabinosine is a competitive inhibitor of viral DNA polymerase and exerts antiviral effects by blocking the synthesis of viral DNA
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Herpes simplex virus and varicella-zoster virus are the most sensitive to it
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However, due to the relatively high toxicity of vidarabine, and the magnitude of toxicity is positively related to the dose, it is not recommended to use it widely.
At present, vidarabine is generally added to topical drugs, such as 3% vidarabine ointment
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Figure 1 The choice of herpes virus antiviral drugs 06 The three drugs, oseltamivir/peramivir/zanamivir, the mechanism of action is: by inhibiting the neuraminidase of the influenza virus, it interferes with the solution of the offspring virus Gather and release
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At present, our country only has oral oseltamivir and intravenous peramivir
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Oscarville is a commonly used anti-influenza drug in clinical practice.
Its side effects are relatively rare (nausea, vomiting, insomnia, dizziness, etc.
), and it is well tolerated by children
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For peramivir, the recommended dose of the Chinese Health Commission is: 300-600 mg for adults; 6 mg/kg for newborns less than 30 days old; and 10 mg/kg for children between 91 days and 17 years old
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Intravenous drip, once a day, 1-5 days, severe cases can appropriately extend the course of treatment
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Treatment Direction: peramivir common adverse reactions included gastrointestinal symptoms, dizziness, headache
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Professor Shu Sainan suggested that if it is a common flu case that does not require injections, oseltamivir is sufficient, and there is no need for excessive injection treatment
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07 Amantadine/Rimantadine Amantadine and rimantadine are ion channel M2 blockers
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Treatment direction: Only effective against influenza A virus, but currently there are monitoring data showing that influenza A virus is resistant to it, and in children and elderly patients, there is no evidence that amantadine and rimantadine have preventive treatment Or shorten the course of the disease
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Adverse reactions: orthostatic hypotension, syncope, hallucinations, etc.
Serious adverse reactions include psychosuppressive malignant syndrome, psychosis, and suicidal ideation
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Therefore, Professor Shu Sainan believes that there are better and more effective anti-influenza virus drugs (such as oseltamivir, etc.
) in clinical practice.
Unless necessary, the rest do not need to use amantadine and rimantadine
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08 Baloxavir Baloxavir is a new drug that only entered the Chinese market this year.
It directly acts on the CAP structure of the 5'end of the host mRNA, thereby inhibiting the transcription of the influenza virus itself.
It is a powerful anti-A type And drugs for influenza B virus
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The biggest advantage of baloxavir is that it only needs to be used once throughout the course of treatment
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Usage: >12 years old: 40mg or 80mg, Qd×1d; <12 years old: 10mg, 20mg or 40mg; the dosage is determined according to body weight
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The adverse reactions are relatively few, and only two serious adverse events (incarcerated inguinal hernia and aseptic meningitis) have been reported in the subjects
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Interferon 09/pegylated interferon interferon is the most commonly used drug for infection doctors to treat viral hepatitis
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Route of administration: intramuscular injection, subcutaneous injection, atomization, topical application
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Treatment direction: It is mainly used for the treatment of hepatitis B and C abroad; China has expanded it to the treatment of some respiratory diseases, including: bronchiolitis, viral pneumonia, herpes pharyngitis, hand, foot and mouth disease, Epstein-Barr virus related diseases (IM , CAEBV, EBV-HLH), CHB, HCV; however, for the treatment of respiratory diseases, China currently lacks corresponding dosage forms.
For example, in the treatment of atomization, China lacks atomized drugs
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Therefore, Professor Shu Sainan reminds everyone that we must carefully choose the interferon used for nebulization treatment, and pay particular attention to whether the interferon's adjuvant ingredients contain hydroxyethyl starch, because hydroxyethyl starch cannot be degraded when deposited in the lungs.
Pediatric clinical medication must consider the impact of medication use on children's future health! Adverse reactions: Children who receive interferon injection for the first time may have the following adverse reactions: Figure 2 Possible Adverse Reactions of Interferon Injection When interferon is injected subcutaneously, it can produce flu-like adverse reactions.
Imagine this drug inhalation.
What happens in the airway? Professor Shu Sainan said frankly: "Interferon has relatively more side effects, so I basically don’t use interferon for atomization.

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In addition, this medicine is not necessary during pregnancy.
Even, I suggest that patients who have used interferon before pregnancy should have a longer period of time before they can plan for pregnancy
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"09 Lamivudine/Adefovir/Entecavir Lamivudine, Adefovir and Entecavir are also used in the treatment of hepatitis B.
There are different drug options for different ages (Figure 9)
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Figure 3 Antibiotics hepatitis B drug application adverse reactions: neutropenia, anemia, kidney damage, dizziness, headache
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summarize virus infection is self-limiting, and many viruses and no specific drug
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Shu tournament professor men stressed for Viruses with specific drugs, such as influenza viruses, should be actively used.
As long as they are considered as influenza-like cases, oseltamivir should be used as soon as possible! For many viruses without specific drugs, do not force the use of drugs, but According to the knowledge of the system and the specific condition of the patient that you have learned, you can choose the right medicine (including the dosage and route of administration) at the right time for treatment
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Source of this article: Pediatric Channel of the Medical Circle Author of this article: Kaka Editor in charge: CiCi recommends that you want to run to the toilet as soon as you read the exam.
It may not be pretending to be sick.
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Bloating, why does the child always have abdominal distension? It may be these diseases.
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How to achieve individualized treatment for children with different types of milk protein allergies? If there is no coughing or wheezing, it is not asthma? The medical community strives for the accuracy and reliability of the published content when it is reviewed and approved, but it is not about the timeliness of the published content and the accuracy of the cited information (if any) make any commitments and guarantees and integrity, nor take responsibility for the content of these obsolete any responsibility for the information may be inaccurate or incomplete, etc.
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