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Although ribavirin is a broad-spectrum antiviral drug, the virus used in the human body mainly for treatment is limited, and the side effects are quite large.

This is really not an alarmist. Today we will talk through authoritative evidence.

Common Misunderstanding 1: Ribavirin is used to treat common colds

From the textbook, although there is no specific antiviral drug, ribavirin can be applied in the early stage. The authoritative textbooks say so, will it be misused?

Everyone knows that the content of the textbook is somewhat lagging, and many times it is not very detailed.

The etiology of the common cold is most common with rhinovirus (30% to 50%), followed by coronavirus (10% to 15%), respiratory syncytial virus (5%), parainfluenza virus (5%), adenovirus ( <5%) and enterovirus (<5%).

The indications in the ribavirin injection instructions clearly indicate “pneumonia and bronchitis caused by respiratory syncytial virus”, and the instructions for ribavirin tablets and granules are more injectable than the injections in the indications. Can be used for “skin herpes virus infection”, none of which can be used for the common cold.

Special precautions are “not suitable for patients who have not been diagnosed with respiratory syncytial virus infection in the laboratory”.

In other words, ribavirin is mainly used to treat bronchitis and pneumonia caused by respiratory syncytial virus, not the common cold; ribavirin is not really a so-called broad-spectrum antiviral drug (in vitro test can be regarded as a broad spectrum) However, there is currently no evidence that the human body is widely distributed. There are many kinds of viruses, and it is mainly used for the treatment of respiratory syncytial virus infection, and the virus is not the most common virus of the common cold.

If the laboratory is diagnosed as a respiratory syncytial virus infection and is not a respiratory syncytial virus infection, the use of ribavirin is generally a super-instruction.

If it is to be used, anti-viral drugs may be considered, mentioning neuraminidase inhibitors or ion channel M2 blocker-related drugs, and ribavirin is not recommended.

Ribavirin is not recommended for the treatment of the common cold in the World Health Organization’s Essential Medicines List and the US Food and Drug Administration’s Drug Specification.

In short, the common cold does not recommend the use of antiviral drugs, if it is used, neither ribavirin is recommended nor recommended.

Common Mistake 2: Ribavirin is used to treat influenza

Influenza is an acute respiratory infection caused by the flu virus.

“The Rational Use of Anti-Influenza Virus Drugs for the Treatment of Influenza Experts Consensus (2016)” states that “in vitro experiments have shown that ribavirin has an anti-influenza effect, but due to serious adverse reactions of ribavirin, clinical There are few studies on ribavirin in the treatment of influenza, and most of the existing studies show that ribavirin is not effective in treating influenza.” What does this mean? This means that there is currently no evidence that the use of ribavirin in the body is effective against the flu, and the side effects are large and are not recommended.

“Common Application of Anti-Influenza Virus Drugs to Treat Influenza Experts (2016)”, “Children’s Influenza Diagnosis and Treatment Expert Consensus (2015 Edition)”, “Influenza Treatment Program (2018 Edition)” and Current Textbook ” The anti-influenza drugs recommended by Internal Medicine (8th Edition) include neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and M2 ion channel blockers (amantadine and rimantadine). The last three authoritative sources do not mention ribavirin and the drugs.

Therefore, ribavirin is not recommended for influenza.

Common Misunderstanding 3: Ribavirin for Acute Infectious Diarrhea in Children

The cause of acute infectious diarrhea in children is mostly viral infection, and rotavirus and norovirus are the most common.

There are currently no antiviral drugs for causing gastrointestinal infections. There is no evidence for the use of antiviral drugs in the treatment of acute diarrhea. It is not recommended.

The Fever: Sanford Antimicrobial Therapy Guide (2016 Edition) also states that antiviral medications are not recommended for diarrhea in infants and children.

Thus, ribavirin is not used for acute infectious diarrhea in children.

Common Misunderstanding 4: Ribavirin for Conventional Treatment of Hand, Foot and Mouth Disease

“Infectious Diseases” (8th Edition) Hand, Foot and Mouth Disease section has written about pathogenic therapy. “There is still a lack of specific and highly effective antiviral drugs, and ribavirin antiviral therapy can be used as appropriate.”

In the current textbook “Pediatrics” (8th Edition), the Hand, Foot and Mouth Disease section does not recommend antiviral therapy in both general and severe cases, and there is no mention of ribavirin.

The US Centers for Disease Control and Prevention has not mentioned anti-viral drugs for hand, foot and mouth disease.

There is currently no definitive and effective anti-EV71 virus, and ribavirin has been shown to inhibit EV71 replication and partially inactivate virus in vitro, but it can be considered – but it is a severe case.

Thus, antiviral drugs, including ribavirin, are insufficient for adequate evidence-based medical evidence for the treatment of hand, foot and mouth disease and cannot be used as a conventional drug. Unless the child’s symptoms are heavy, considering that part of the hand, foot and mouth disease is caused by EV7l, if the trade-offs outweigh the disadvantages, consider using the ribavirin treatment with reference to the consensus.

Common Mistake 5: Ribavirin Injection for Aerosol Treatment

Non-atomized preparations cannot meet the requirements of atomized particles, cannot be removed through the respiratory tract, may be deposited in the lungs, thereby increasing the incidence of pulmonary infections; intravenous preparations contain preservatives such as phenol, nitrite, etc. Induced asthma attacks.

It is not recommended to use ribavirin injection for aerosol therapy because it is a super-instructive drug, even an irrational drug, plus the antiviral spectrum of ribavirin and its side effects.

 

What circumstances can ribavirin be used?

Although ribavirin is not so versatile, it is not all-powerful and can be used in the following treatments:

  • Patients with viral pneumonia and bronchitis caused by respiratory syncytial virus.
  • Patients with herpes simplex virus infection.
  • Ribavirin aerosol can be used for viral rhinitis, angina, pharyngitis or oropharyngeal virus infection.
  • Severe cases of hand, foot and mouth disease.
  • Epidemic hemorrhagic fever.
  • Combined with interferon for the treatment of chronic hepatitis C.
  • Adult measles (no need for measles in children).

The reason why ribavirin has changed from “In the limelight” to “excessive star” is mainly with the development and discovery of medicine. Modern medicine pays special attention to evidence, especially the evidence of efficacy and safety. The mechanism of action of bavirin is not fully understood. The drug is a broad-spectrum antiviral drug, but it is only relative to in vitro tests, and the clinical effects after use in humans lack sufficient evidence, and the spectrum of the virus that can be treated is also small. Clinical effects have been found to be relatively large.

The FDA has approved very few indications for treatment with ribavirin. Aerosol formulations are only approved for the treatment of severe lower respiratory tract infections caused by respiratory syncytial virus, especially in preterm infants, hospitalized patients with underlying lung disease. Oral dosage forms are only approved for the combined use of interferon for the treatment of chronic hepatitis C (ineffective for individual use).

In addition, it is worth mentioning that the safety and efficacy of ribavirin tablets in the treatment of adenovirus, respiratory syncytial virus, parainfluenza or influenza virus infection have not been determined in the FDA approved ribavirin tablet instructions. Therefore, ribavirin tablets should not be used in these treatments” – these viruses are common causes of common colds, flu and other diseases.

 

Precautions

■ Before the start of ribavirin, during treatment and at least six months after discontinuation of the drug, whether male or female, contraception should be used; if ribavirin has to be used, it should be confirmed that it is not yet pregnant; Ribavirin should be avoided; ribavirin should be contraindicated in pregnant women and their partners; ribavirin is not recommended for lactating women.

Ribavirin not only has obvious teratogenicity and germinal toxicity, but also causes significant atrophy of spermatogenic duct, decreased sperm concentration and abnormal morphology, and ribavirin can enter and accumulate in red blood cells. Ribavirin is the “highest alert” in the FDA’s gestational grading, grade X, which is contraindicated in pregnant women. In all animal experiments, there is sufficient information to show that it has significant teratogenic effects and/or embryo effects.

The FDA has a serious warning about ribavirin: the drug is teratogenic to the fetus! Even exposure to as low as 1% of the therapeutic dose produces a significant likelihood of fetal malformation. Therefore, women of childbearing age and their sexual partners should avoid pregnancy within 6 months of using ribavirin, and should use at least two reliable contraceptives (such as oral contraceptives + condoms). Medical staff in pregnancy should also avoid aerosol inhalation of ribavirin for the patient.

Therefore, the doctor prescribed ribavirin. If you want to prepare for pregnancy or are pregnant, you should tell the doctor if you can change other drugs. As a doctor, you should ask if you have any pregnancies before you give this medicine to the patient. Be sure to do contraception during the last six months to avoid pregnancy (don’t neglect the need for contraception for both male and male partners who are planning to have children); breastfeeding women should stop breastfeeding if they have to take this medicine. throw away.

■ Ribavirin is not recommended for patients with severe anemia, thalassemia, and sickle cell anemia. Hemoglobin should be monitored frequently before and after treatment and during treatment.

■ Patients with pancreatitis should not use ribavirin.

■ Patients with a history of heart disease or significant heart disease should not use ribavirin. This medicine may cause fatal heart disease and non-fatal myocardial damage, myocardial infarction. If ribavirin is used, any heart disease worsens.

■ Patients with abnormal liver and kidney function should be used with caution. Ribavirin is not recommended for patients with creatinine clearance <50 ml/min. In elderly patients, the possibility of anemia in this product is greater than that in young patients. The renal function of the elderly is mostly decreased, which may lead to accumulation. It is not recommended for elderly patients.

■ Ribavirin should not be used in active tuberculosis patients.

■ Patients with autoimmune liver disease are banned.

■ Use with caution in patients with respiratory diseases (chronic obstructive pulmonary disease or asthma). This medicine can cause difficulty in breathing, chest pain, etc., especially in high-dose applications. Another can be seen rhinitis.

■ When ribavirin is used for intravenous drip, pay attention to the drug concentration and infusion rate. It is clearly recommended in the instructions to dilute with sodium chloride injection or 5% dextrose injection into a 1 mg solution containing 1 mg of the solution.

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