The rise in the incidence of SARS-CoV-2 has caused a surge in demand for drugs. And some of the most popular products are those that boost immunity and help the body resist the virus. Our article will tell you which drugs in this group a pharmacist can confidently offer if requested, and how to justify the recommendation.
It should be said right away that there is no specific prevention of COVID-19 [1]. There are no drugs that have been proven in studies to prevent infection by SARS-CoV-2, at least as of early April 2021. But this does not mean that today we are completely unarmed against infection. The virus is still very young. While scientists around the world are working to create new drugs for the treatment and prevention of COVID-19, doctors are using long-known drugs, selected empirically, and gaining their own experience of successful or not so successful therapy.
Antivirals and immunomodulators to enhance immune defense
One striking example is the antiviral drug umifenovir.
For the first time, encouraging clinical experience with its use was reported by Chinese doctors who published an article in The Lancet on the therapeutic strategy for treating COVID-19 in several clinics [2]. It talks about the use of umifenovir [Arbidol], approved for the treatment of influenza in China, for coronavirus pneumonia. The basis for this prescription was the results of in vitro studies demonstrating the inhibitory effect of umifenovir on SARS [3]. Let us remember that SARS is the closest relative of the coronavirus SARS-CoV-2, the causative agent of severe acute respiratory syndrome, which caused an epidemic in 2002. It is known that the genome of SARS-CoV-2 is 79.5% identical to the genetic code of SARS [4]. Read about the biology of coronavirus here.
The preventive capabilities of umifenovir are due to interferon-inducing activity, stimulation of cellular and humoral immunity. Among its indications is the prevention and treatment of influenza A and B and other acute respiratory viral infections in children from two years of age and adults.
Currently, umifenovir and two other antiviral drugs not registered in the Russian Federation - remdesivir and favipiravir - are undergoing clinical trials in patients with COVID-19. While remdesivir and favipiravir are new and insufficiently studied, umifenovir has quite a wealth of experience in clinical use. What's more, it is available over-the-counter and is generally well tolerated, so it can be recommended to consumers.
What can you offer?
Along with umifenovir for the prevention of acute respiratory viral infections, including COVID-19, other over-the-counter drugs can be recommended - immunomodulators and immunostimulants, for example, azoximer bromide in the form of tablets and suppositories (used in adults and children from three years of age for the treatment and prevention of acute and chronic respiratory diseases in the stage of exacerbation and remission); an antiviral drug that induces the production of interferons, kagocel (prevention and treatment of influenza and other acute respiratory viral infections in adults and children over three years of age), meglumine acridone acetate in tablet form (prevention and complex therapy of influenza and other acute respiratory viral infections in adults and children over four years of age), tilorone tablets 125 mg (prevention and complex therapy of influenza and ARVI in adults and children from seven years of age).
What should you tell your visitor about?
Drugs with antiviral and immunomodulatory properties help resist infection and the development of respiratory viral infections, increasing the immune response and preventing viral replication. And although there is no proven data on their effectiveness against the causative agent of the current pandemic, SARS-CoV-2, it is nevertheless appropriate to take drugs from this group.
Didn't prescribe any medications
How many parents who called a doctor to see their child with a fever and cough are ready to accept this situation: the pediatrician examined the little patient and... did not prescribe any medications? But, if this is your case, know: you are lucky to have a doctor.
In 2021, new clinical guidelines for the treatment of ARVI, developed by the Union of Pediatricians of Russia, were approved. Most of them are devoted to what NOT to do when you have a cold. The main thing is that there is no need to treat, paradoxically as it may seem.
“ARVI is the most common reason for the use of various medications and procedures, most often unnecessary, with unproven effects, and often causing side effects. Therefore, it is very important to explain to parents the benign nature of the disease and the expected duration of symptoms, as well as to reassure them that minimal interventions are sufficient,” the document says.
AiF asked Vladimir Tatochenko, a professor at the National Medical Research Center for Children's Health and an expert at the World Health Organization, to explain why it is not necessary to give a child the usual medications for a cold.
Photo: AiF
Interferon preparations for the prevention of coronavirus
Another group of drugs that can be offered to prevent respiratory infections, including COVID-19, are interferons. The activity of parenteral interferon alpha-2a has been demonstrated against MERS-CoV, the coronavirus that causes severe Middle East respiratory syndrome, an outbreak of which was reported in 2012 [5]. The effectiveness of interferon has also been studied during SARS infection: studies published in 2009 confirmed that interferon alpha promotes the production of its own interferon, the production of which is blocked by coronavirus [6].
The domestic temporary recommendations of the Russian Ministry of Health on COVID-19 describe the intranasal administration of a solution of recombinant interferon alpha for the prevention of the disease in both children and adults, including pregnant women, as well as the treatment of mild forms in patients under 60 years of age without concomitant chronic diseases [1 ].
The mechanism of the antiviral and immunomodulatory action of interferons is based on the ability to prevent viral infection of cells and suppress viral replication. In addition, interferon alpha enhances the phagocytic activity of macrophages and increases the secretion of antibodies.
What can you offer?
As drugs to enhance the immune response, including during the COVID-19 pandemic, nasal drops or a nasal metered spray of interferon alfa-2b can be recommended.
What should you tell the buyer?
Preparations of human recombinant interferon alpha-2b have antiviral and immunomodulatory properties and are used for the prevention and treatment of acute respiratory viral infections. They are usually well tolerated and are approved for adults, including pregnant and lactating women, and children, including young children.
Therefore, during a pandemic, it is advisable to prevent COVID-19 disease with interferon alpha-2b preparations. If necessary (for example, if the pandemic drags on), the preventive course can be repeated.
Bibliography:
- Prevention, diagnosis and treatment of new coronavirus infection [COVID-19]. Temporary guidelines. Version 5
- Zhang J. et al. Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics //The Lancet Respiratory Medicine. 2020
- Khamitov RA, Loginova S, Shchukina VN, Borisevich SV, Maksimov VA, Shuster AM. Antiviral activity of arbidol and its derivatives against the pathogen of severe acute respiratory syndrome in the cell cultures. Vopr Virusol 2008
- Zhou P. et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin //Nature. 2020
- Omrani AS et al. Ribavirin and interferon alfa-2a for severe Middle East respiratory syndrome coronavirus infection: a retrospective cohort study //The Lancet Infectious Diseases. 2014
- Kuri T. et al. Interferon priming enables cells to partially overturn the SARS coronavirus-induced block in innate immune activation //The Journal of general virology. 2009; 90 : 2686
- Jin YH et al. A rapid advice guideline for the diagnosis and treatment of 2021 novel coronavirus (2019-nCoV) infected pneumonia (standard version) //Military Medical Research. 2020
We collect all materials about COVID-19 that are useful to pharmaceutical workers in a special section of the website.
The most important things on the topic: hand antiseptic, hand hygiene, disinfection in the pharmacy, rules for using masks, myths and facts about coronavirus, pharmaceutical consultation on antipyretic and hypotensive drugs during a pandemic.
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What's next?
In the future, the improvement of therapy will go in the direction of reducing the duration of treatment by increasing the power of the antiviral action of drugs, as well as in the direction of creating a drug that is equally effective against all genotypes of the virus, and developing easy-to-use composite drugs - one tablet will contain 2 or 3 direct acting drug. Taking one tablet a day for what appears to be 6-8 weeks will be enough to completely eliminate the hepatitis C virus.
Chronic hepatitis C virus infection is the first chronic infection in the world that can realistically be eradicated not through a vaccine (which does not exist) but through effective treatment.
How to increase the effectiveness of treatment of infectious diseases in adults and children?
In addition to the use of antiviral drugs, for a speedy recovery from ARVI, adults and children should adhere to some rules:
- give up the habit of carrying the disease “on your feet”;
- depending on the severity of the disease, age and concomitant pathology, maintain bed or semi-bed rest;
- rinse your nose with saline solutions;
- stop taking antibiotics without a doctor’s prescription;
- drink enough liquid – still water, herbal decoctions;
- Ventilate the room regularly and do not forget about wet cleaning.
Author of the article
Belyaev Dmitry Alexandrovich
General doctor
Sources used: https://ria.ru/, https://cyberleninka.ru/
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Effective prevention of influenza and ARVI
Prevention of acute respiratory infections involves maintaining a healthy lifestyle, replenishing vitamin deficiencies and deficiencies of macro- and microelements. During the epidemic, it is recommended to avoid public places, wear protective masks and pay attention to wet cleaning of premises and regular ventilation.
Additional prevention includes vaccination against influenza - optional, but mandatory for people at risk, for example, with immunodeficiencies. Vaccination against streptococcus is also performed. Seasonal and emergency prophylaxis involve the use of specific immunomodulatory agents2.
How to recognize ARVI?
In the structure of respiratory infections, the leading importance is occupied by influenza viruses of types A, B, C. Every year, influenza affects at least 10% of the world's population. The clinical picture of the disease includes general symptoms:
- Fever (temperature rises sharply to febrile levels above 38 °C);
- Headache;
- Aches of muscles, bones;
- Pain in the eyes, photophobia6.
General intoxication is the predominant symptom of influenza, as opposed to other viral infections.
Damage to the respiratory tract occurs in the form of inflammatory reactions. The level of damage depends on the pathogen. In most people, several parts are affected at once, but isolated forms also occur. ARVI involves the appearance of the following types of inflammation:
- rhinitis (runny nose, swelling of the nasal mucosa);
- laryngitis (sore throat, hoarseness, barking cough, swelling of the mucous membrane);
- pharyngitis (sore throat, sore throat, hoarse voice);
- tonsillitis (sore throat, enlarged tonsils);
- tracheitis (dry cough);
- bronchitis (dry or productive cough, wheezing);
- bronchiolitis (dry or productive cough)6.
During an epidemic, the influenza virus often leads to the development of severe viral pneumonia, which is one of the dangerous complications of the disease.
The clinical picture depends on the causative agent of the respiratory disease. However, recognizing the source of infection solely by symptoms is extremely difficult. To confirm infection with a specific virus, laboratory serological diagnostic methods are used.
Two groups of antiviral drugs
According to experts from the Food and Drug Administration (USA), only drugs that have a direct direct effect on the reproduction of the virus can be called antiviral, i.e., the action of these drugs is aimed at destroying the virus and preventing its reproduction.
According to many scientists, all currently existing drugs that fight viruses can be divided into two groups: drugs that act on the viruses themselves, and drugs that activate the body’s own immune defense.
