At present, the common pathogens of respiratory tract infection in clinical practice are:
Influenza virus, respiratory syncytial virus, new coronavirus, and Mycoplasma pneumoniae can cause influenza A, influenza B, respiratory syncytial virus infection, new coronavirus infection, Mycoplasma pneumoniae infection and other diseases, which can be seen in children and immunocompromised people.
So, how to use drugs for multi-pathogen infection of the respiratory tract in children? How to choose special groups?
Medications for influenza virus infection
For people with high fever, more comorbidities, obvious systemic symptoms, infants and young children, and frail people, it is recommended to use antiviral drugs such as oseltamivir, mabaloxavir, zanamivir and other treatments as soon as possible.
(1) Neuraminidase inhibitors
For example, oseltamivir, zanamivir, and peramivir can be used for the prevention and treatment of influenza A and B virus infections. Oseltamivir can be used for the prevention and treatment of influenza A and B in infants and children, and is administered orally. Zanamivir can be used for the prevention and treatment of influenza A and B in children aged 7 years and over and can be administered by inhalation. Peramivir can be used for the treatment of neonates, infants, and children with influenza A and B, and is not recommended as a prophylactic drug for influenza A and B. It can be administered through the intravenous route for severe influenza and children who are intolerant to or absorb oral oseltamivir and zanamivir inhalation due to suspected or known gastric retention, malabsorption, gastrointestinal bleeding.
Special Populations:
Oseltamivir is not recommended for patients with creatinine clearance < 10 mL/minute who require regular hemodialysis and continuous peritoneal dialysis due to severe renal failure.
Zanamivir is contraindicated in patients with lactose allergy and should be avoided in patients with severe asthma. Zanamivir is not recommended for patients with underlying respiratory conditions (e.g., asthma or chronic obstructive pulmonary disease) because of the higher risk of bronchospasm and respiratory decline. Zanamivir should be used with caution in people with a history of psychiatric illness.
Peramivir should be used with caution in patients with renal dysfunction.
(2) RNA polymerase inhibitors/endonuclease inhibitors
For example, mabaloxavir is a prodrug, which can be used for the treatment of uncomplicated influenza A and type A in children ≥ 5 years old, or the treatment of influenza in children aged ≥ 12 years old who are at high risk of influenza-related complications, and the EU drug label recommends it for the treatment of influenza in children ≥ 1 year old.
Take a single dose within 48 hours of the onset of flu symptoms. It is recommended that the body weight < 20kg, 2mg/kg for a single time, and the maximum dose should not exceed 20mg/time; Body weight is 20-80kg, 40mg in a single dose; Body weight > 80kg, a single 80mg, a single course of treatment. Patients with mild to moderate liver impairment (Child-Pugh A-B grade) and renal impairment (creatinine clearance ≥ 50 mL/min) do not need to adjust the dose.
Special Populations:
Do not use laxatives, antacids, or oral supplements (e.g., calcium, iron, magnesium, zinc) that contain high-valent cations. There are no data on severe liver and kidney damage.
Medications for mycoplasma infection
For example, macrolides and tetracyclines have good antibacterial activity against atypical pathogens such as mycoplasma and can be used for the treatment of mycoplasma infection. If macrolide drugs are used for ≥ 3 days, fever persists, or there are manifestations of poor efficacy during the treatment process, such as exacerbation of pneumonia, it can be considered as refractory Mycoplasma pneumoniae pneumonia.
Macrolides such as azithromycin, clarithromycin, and roxithromycin can be used in infants and children; Tetracyclines such as doxycycline and minocycline can be used in children 8 years of age and older, have a definite effect on drug-resistant Mycoplasma pneumoniae pneumoniae, and are suitable for patients who are resistant, unresponsive or refractory to macrolides.
Quinolones such as levofloxacin and moxifloxacin can be used for ≥ 18-year-olds, and off-label drugs for <18-year-olds, which need to be cautious, because they have definite efficacy against drug-resistant Mycoplasma pneumoniae pneumonia and are suitable for the treatment of suspected or confirmed Mycoplasma pneumoniae resistant severe Mycoplasma pneumoniae pneumoniae, macrolide drug-unresponsive Mycoplasma pneumoniae pneumoniae pneumoniae pneu The course of medication is generally 7-14 days.
Special Populations:
Macrolides are contraindicated in patients with prolonged Q-T intervals and should be avoided in patients with serum transaminase elevations greater than three times the normal limit and a high risk of underlying cardiovascular disease (eg, congestive heart failure). Those who are using cisapride and colchicine are prohibited from clarithromycin and roxithromycin.
Doxycycline and minocycline are contraindicated in people who are using isotretinoin.
Quinolones should be avoided in patients with a history of peripheral neuropathy, tendon disease, myasthenia gravis, prolonged Q-T interval, uncorrected hypokalemia, heart failure with reduced left ventricular ejection fraction, epilepsy, and those taking class IA or III antiarrhythmic drugs, cisapride.
Moxifloxacin is contraindicated in patients with elevated aminotransferases greater than 5 times the upper limit of normal, liver impairment (Child Pugh class C), and clinically significant bradycardia.
Medications for respiratory syncytial virus infection
There are no specific antiviral drugs for respiratory syncytial virus (RSV).
Ribavirin is a broad-spectrum antiviral drug that can inhibit viruses such as RSV, can be administered intravenously or orally, and is not routinely recommended for the treatment of RSV lower respiratory tract infection in children, but may benefit from immunosuppression (such as hematopoietic stem cell transplantation). The recommended dose of ribavirin is 10-15 mg/(kg · day) divided into 2 intravenous infusions.
Special Populations:
It is contraindicated in patients with a history of significant or unstable heart disease, decompensated liver cirrhosis, hepatic insufficiency Child-Pugh B/C, autoimmune liver disease, creatinine clearance <50ml/min, active tuberculosis, uncontrolled severe mental disorder, severe Eastern Mediterranean anemia, history of severe mental illness in childhood, sickle cell anemia, and pancreatitis.
For lower respiratory tract infections caused by RSV infection, recombinant human α interferon antiviral therapy can be tried. According to the Expert Consensus on the Diagnosis, Treatment and Prevention of Respiratory Syncytial Virus Infection in Children (2020), interferon α1b is recommended to be 2-4 μg/(kg · times), 2 times/d, and the course of treatment is 5-7 days; Interferon α2b is recommended to be 100,000-200,000 IU/(kg · times), 2 times/d, and the course of treatment is 5-7 days.
Special Populations:
It is contraindicated in patients with a history of angina pectoris or myocardial infarction, severe heart disease, severe hepatorenal and bone marrow dysfunction, severe respiratory failure, autoimmune hepatitis, hepatic decompensation, and a history of mental illness.
Medications for coronavirus infection
There are currently no effective antiviral drugs for coronavirus infection in children, nirmatrelvir/ritonavir and deuterium hydrobromide can be tried.
(1) Nirmatrelvir/ritonavir
Protease inhibitors, approved by the FDA for mild to moderate ≥ 12-17 years old with a weight of 40 kg within 5 days of onset and with high-risk factors for progression to severe disease. It is recommended that nirmatrelvir 300 mg combined with ritonavir 100 mg be used every 12 hours for 5 days.
Special Populations:
It is contraindicated in patients with severe liver injury, glomerular filtration rate <30ml·min-1, galactose intolerance, glucose-galactose malabsorption, total lactase deficiency and those who are using cisapride, lovastatin, simvastatin, fusidic acid, clozapine, pimozide, lurasidone, quetiapine, diazepam, estazolam, flurazepam, triazolam, avanafil, sildenafil, meperidine. Use with caution in patients with pre-existing liver disease.
(2) Deuterium remidevir hydrobromide
It can inhibit RNA synthesis and is a deuterated derivative of remdesivir, which is approved by the FDA for intravenous remdesivir for children aged ≥ 2 days and weighing ≥ 3 kg of new coronavirus infection.
Special Populations:
Deuterium hydrobromide tablets for renal insufficiency need to be dosed, but there is no basis. Deuterimidevir hydrobromide tablets should be used with caution in combination with P-gp inducers (eg, rifampicin, carbamazepine) or inhibitors (eg, cyclosporine, verapamil, amiodarone).
(3) Amubarvimab/romlusevimab
Monoclonal antibodies can be used in combination to treat adolescents (12-17 years, weighing ≥ 40 kg) with mild to moderate size and high risk factors for progression to severe disease.
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Tips: This article is only a popular science article, does not provide professional diagnosis and treatment opinions, specific diagnosis and treatment, please under the guidance of professional doctors.