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Treatment of Acute Respiratory Viral Infections
Infectiones respiratorias acutas
For medical students2 min readUpdated 2026-10-10
The management of acute respiratory viral infections is based on pathogenetic body support and symptomatic control. Etiotropic therapy is limited due to the lack of highly effective specific agents.
Etiotropic approachSpecific antiviral drugs are practically absent.
AntibioticsIndicated strictly for secondary bacterial infections.
Main therapyPathogenetic and symptomatic treatment forms the basis of care.
Nonspecific defenseUse of interferons and oxolinic ointment for viral inactivation.
Etiotropic Therapy: Possibilities and Limitations
To date, medicine lacks a wide range of specific agents for the direct targeting of ARVI pathogens. Development of RNA uncoating inhibitors and cellular receptor blockers remains in the research stage.
Clinical practice utilizes nonspecific methods:
Intranasal $\alpha$-interferon to stimulate local immune responses.
Oxolinic ointment or drops that inactivate extracellular forms of adenoviruses, rhinoviruses, and myxoviruses.
Pathogenetic and Symptomatic Treatment
This is a key stage of therapy aimed at relieving the patient's condition and supporting the body's defenses:
Detoxification: abundant warm fluids to eliminate viral waste products.
Antipyretics: fever control when necessary.
Vitamin therapy: use of vitamin C for general bodily support.
Desensitizing therapy: to reduce the severity of inflammatory responses.
When to Prescribe Antibiotics?
It is essential to remember that antibacterial drugs do not affect viruses. Their prescription is justified in only one scenario: the development of a secondary bacterial infection. Inappropriate use of antibiotics during uncomplicated ARVI is unacceptable.
Which specific drugs belong to viral RNA uncoating inhibitors?
Viral RNA uncoating inhibitors include M2 channel blockers, also known as adamantanes. The only specific drug of this group mentioned in sources is rimantadine.
Rimantadine — disrupts viral uncoating (inhibits viral exit from the endosome), specific for influenza A virus.
Although it has proven antiviral effects, high resistance to this drug is currently observed.
Which antipyretics are drugs of choice in uncomplicated ARVI?
The drugs of choice (first-line agents) for managing febrile illness during respiratory infections are ibuprofen and paracetamol.
Ibuprofen — used as an antipyretic for febrile fever.
Paracetamol (acetaminophen) — an effective antipyretic that is also the safest agent during pregnancy.
These drugs are administered strictly "as needed" upon reaching a temperature threshold; routine scheduled use is not recommended. Other nonsteroidal anti-inflammatory drugs are permitted solely under strict individual indications.
What bacterial complications most frequently require antibiotic therapy during ARVI?
Antibacterial therapy during ARVI is required when complications develop due to secondary bacterial flora. These include:
Bacterial bronchitis.
Pneumonia.
Otitis media — ear inflammation accompanied by persistent, throbbing, or shooting pain.
Sinusitis — inflammation of the paranasal sinuses, such as maxillary sinusitis or frontal sinusitis.
Antibacterial therapy is recommended for suspected concurrent bacterial infection, failure of pathogenetic, symptomatic, and antiviral treatment, and moderate-to-severe complicated ARVI caused by bacterial invasion.
Which drug groups are considered nonspecific antivirals in ARVI?
Nonspecific antiviral agents in the treatment of ARVI include:
$\alpha$-interferon — administered intranasally.
Oxolin — applied as an intranasal ointment or drops, inactivating extracellular forms of adenoviruses, rhinoviruses, and myxoviruses.
Why are antibiotics not prescribed immediately for ARVI?
Antibiotics act exclusively on bacteria. They are useless against viral infections and are only prescribed when secondary bacterial complications develop.
What is the mechanism of action of oxolinic ointment?
It inactivates extracellular forms of viruses (adenoviruses, rhinoviruses, and myxoviruses) when applied to the nasal mucosa.
What is the basis of ARVI treatment?
The foundation is pathogenetic and symptomatic therapy aimed at detoxification, temperature reduction, and body support.
Go deeper
Mechanisms of action of viral RNA uncoating inhibitors.
Comparative efficacy of various $\alpha$-interferon formulations.
Diagnostic criteria for secondary bacterial infection.
The role of desensitizing agents in managing mucosal edema.
Prospects for the development of cellular receptor blockers.