Current approaches to rational therapy of acute respiratory infections

Acute respiratory viral infections (ARVI) continue to be a major public health concern, ranking among the leading causes of medical consultations and accounting for up to 90–95% of all infectious disease morbidity. Although most cases are mild to moderate in severity, some patients may develop severe or even life-threatening conditions. The progression to severe disease is determined by viral virulence factors, host immune response characteristics, underlying comorbidities, and delayed initiation of appropriate therapy. The current approach to the rational management of acute respiratory infections is grounded in the principles of evidence-based medicine, including strict differentiation between viral and bacterial etiology, minimization of polypharmacy, and categorical avoidance of unjustified antibiotic prescription. An optimal therapeutic strategy requires a combination of systemic and local interventions: etiotropic and immunomodulatory agents, as well as topical preparations to control inflammation and relieve pain in the oropharynx. Inosine pranobex exhibits a dual mechanism of action — direct antiviral activity against a broad spectrum of respiratory viruses and a pronounced immunomodulatory effect. In ARVI involving the respiratory tract, catarrhal syndrome develops and is classified according to the anatomical level of inflammation. In pharyngitis, the use of direct-acting topical agents is justified to alleviate symptoms (pain relief and reduction of inflammation). Non-steroidal anti-inflammatory drugs, including benzydamine, are widely used for this purpose. Benzydamine provides marked local anti-inflammatory and analgesic effects in pharyngitis and tonsillitis of various etiologies. The timely and etiopathogenetically justified use of a systemic antiviral agent (inosine pranobex) in combination with topical symptomatic therapy (benzydamine) may contribute to more rapid symptom resolution and a shorter recovery period.

1. Shahan B. Respiratory conditions: upper respiratory tract infections / B. Shahan, C. Barstow, M. Mahowald // FP Essent. – 2019. – Vol. 486. – P. 11-18.

2. Santus P. Respiratory syncytial virus burden and risk factors for severe disease in patients presenting to the emergency department with flu-like symptoms or acute respiratory failure / P. Santus, D. Radovanovic, M.R. Gismondo, et al. // Respir Med. – 2023. – Vol. 218. – P. 107404.

3. O sostoyanii sanitarno-epidemiologicheskogo blagopoluchiya naseleniya v Rossiyskoy Federatsii v 2024 godu: Gosudarstvennyy doklad. – M.: Rospotrebnadzor, 2025. (In Russian)

4. Kuchar E. Pathophysiology of clinical symptoms in acute viral respiratory tract infections / E. Kuchar, K. Miskiewicz, A. Nitsch-Osuch, L. Szenborn // Adv Exp Med Biol. – 2015. – Vol. 857. – P. 25-38.

5. Zhdanov K.V. Perspektivy rasshireniya vozmozhnostey etiotropnoy terapii ORVI u detey mladshego shkolnogo vozrasta / K.V. Zhdanov, Yu.V. Lobzin, A.U. Sabitov, E.V. Esaulenko, P.V. Sorokin // Antibiotiki i khimioterapiya. – 2025. – T. 70, No. 1-2. – S. 29-36. (In Russian)

6. Virusnye pnevmonii: ehpidemiologiya, diagnostika, terapiya, profilaktika / A.V. Gorelov, S.N. Avdeev, E.V. Esaulenko, A.G. Malyavin i soavt. – M. Izdatel’stvo «Media Sfera», 2024 – 220s. (In Russian)

7. Gladkov S.A. Kliniko-morfologicheskie sopostavleniya v sluchayakh letalnykh iskhodov pri grippe v 2009-2011 gg. / S.A. Gladkov, I.V. Grigoreva, E.V. Esaulenko, V.A. Tsinserling, V.A. Dedov // Zhurnal infektologii. – 2011. – T. 3, No. 4. – S. 55-61. (In Russian)

8. Sabitov A.U. Metaanaliz randomizirovannykh kontroliruemykh klinicheskikh issledovaniy effektivnosti preparata riamilovir v etiotropnoy terapii ostroy respiratornoy virusnoy infektsii / A.U. Sabitov, O.P. Kovtun, N.A. Batskalevich, O.V. Maltsev, K.V. Zhdanov, E.V. Esaulenko, E.P. Tikhonova, Yu.S. Kalinina, P.V. Sorokin, S.V. Chepur, A.V. Stepanov // Antibiotiki i khimioterapiya. – 2021. – T. 66, No. 5-6. – S. 48-57. (In Russian)

9. Forchette L. A comprehensive review of COVID-19 virology, vaccines, variants, and therapeutics / L. Forchette, W. Sebastian, T. Liu // Curr Med Sci. – 2021. – Vol. 41. – P. 1037-1051.

10. Bassetti M. NSAIDs for acute respiratory infections / M. Bassetti, M. Andreoni, P. Santus, F. Scaglione // J Chemother. – 2024. – Vol. 37, No. 4. – P. 304-311.

11. Marseglia G.L. Ketoprofen lysine salt treatment in adolescents with acute upper respiratory infections: a primary-care experience / G.L. Marseglia, D. Veraldi, G. Ciprandi // Minerva Pediatr (Torino). – 2023. – Vol. 75. – P. 890-895.

12. Airway CD8+ T cells are associated with lung injury during infant viral respiratory tract infection // Am J Respir Cell Mol Biol. – 2016. – Vol. 54, No. 6. – P. 822-830.

13. Ploskireva A.A. Rasprostranennye virusnye infektsii v praktike vracha-terapevta: upravlenie riskami / A.A. Ploskireva, S.V. Nikolaeva // Poliklinika. – 2026. – No. 1. – S. 8-12. (In Russian)

14. Mendelsoni I.M. Mestnaya terapiya vospaleniy glotki i gortani u detey / I.M. Mendelsoni, I.B. Popovich, N.V. Prozorenko // Voprosy prakticheskoy pediatrii. – 2019. – T. 14, No. 5. – S. 76-82. (In Russian)

15. Schaad U.B. Diagnosis and management of recurrent respiratory tract infections in children: a practical guide / U.B. Schaad, S. Esposito, C.H. Razi // Arch Pediatr Infect Dis. – 2015. – Vol. 4, No. 1. – P. e31039.

16. Toivonen L. Burden of recurrent respiratory tract infections in children: a prospective cohort study / L. Toivonen, S. Karppinen, L. Schuez-Havupalo, T. Teros-Jaakkola, J. Vuononvirta, J. Mertsola, Q. He, M. Waris, V. Peltola // Pediatr Infect Dis J. – 2016. – Vol. 35, No. 12. – P. e362-e369.

17. Chiappini E. Prevention of recurrent respiratory infections: inter-society Consensus / E. Chiappini, F. Santamaria, G.L. Marseglia, P. Marchisio, L. Galli, R. Cutrera, M. de Martino, S. Antonini, P. Becherucci, P. Biasci, et al. // Ital J Pediatr. – 2021. – Vol. 47, No. 1. – P. 211.

18. Chi H. Etiology of acute pharyngitis in children: is antibiotic therapy needed? / H. Chi, N.C. Chiu, W.C. Li, F.Y. Huang // J Microbiol Immunol Infect. – 2003. – Vol. 36, No. 1. – P. 26-30.

19. Rozhnitsa A.S. Ostrye respiratornye infektsii u detey: klinicheskie rekomendatsii / A.S. Rozhnitsa, E.A. Malinovskaya. – M.: GEOTAR-Media, 2021. (In Russian)

20. Sliva J. Inosine Pranobex: A Key Player in the Game Against a Wide Range of Viral Infections and Non-Infectious Diseases / J. Sliva, C.N. Pantzartzi, M. Votava // Adv Ther. – 2019. – Vol. 36, No. 8. – P. 1878-1905.

21. Obshchaya kharakteristika lekarstvennogo preparata Oralsept® spray, LP-№(001324)-(RG-RU) ot 15.04.2025. URL: https://pharma.eaeunion.org/pharma/registers/26/ru/register (data obrashcheniya: 11.09.2026). (In Russian)

22. Beran J. Inosine pranobex is safe and effective for the treatment of subjects with confirmed acute respiratory viral infections / J. Beran, E. Šalapová, M. Špajdel // BMC Infect Dis. – 2016. – Vol. 16. – P. 648.

23. Klinicheskie rekomendatsii «Gripp u detey» / «Gripp u vzroslykh». – M., 2025. – URL: https://cr.minzdrav.gov.ru (data obrashcheniya: 06.07.2026). (In Russian)

24. Klinicheskie rekomendatsii «Ostrye respiratornye virusnye infektsii (ORVI) u detey». – M., 2022. – URL: https://cr.minzdrav.gov.ru (data obrashcheniya: 06.07.2026). (In Russian)

25. Majewska A. Inosine pranobex – cytotoxic activities and effect on replication of human parainfluenza viruses, enteroviruses and adenoviruses in vitro / A. Majewska, W. Lasek, G. Młynarczyk // Med Dosw Mikrobiol. – 2015. – Vol. 67, No. 2. – P. 107-113.

26. Majewska A. Inhibition of adenovirus multiplication by inosine pranobex and interferon-α in vitro / A. Majewska, W. Lasek, M. Janyst, et al. // Cent Eur J Immunol. – 2015. – Vol. 40, No. 4. – P. 395-399.

27. Yankova V.G. Kachestvo raspyleniya dozirovannykh spreev: sravnitelnoe issledovanie benzidaminsoderzhashchikh preparatov / V.G. Yankova, O.A. Gobyzov, M.N. Ryabov, V. Yu. Grigoreva, I.L. Udyanskaya, A.A. Zhukova, T.K. Slonskaya, O.N. Plakhotnaya, N.B. Epshteyn, M.P. Pomazkina, S.V. Gribanova // Voprosy prakticheskoy pediatrii. – 2025. – T. 20, No. 5. – S. 39-48. (In Russian)

28. Yankova V.G. Kachestvo raspyleniya spreev kak mera effektivnosti dostavki preparatov benzidamina / V.G. Yankova, S.V. Gribanova, O.A. Gobyzov, M.N. Ryabov, I.L. Udyanskaya, V.Yu. Grigoreva, I.I. Krasnyuk, A.I. Galayko // Pediatriya. – 2017. – T. 96, No. 5. – S. 126-131. (In Russian)

29. Savenkova M.S. Problemy i vozmozhnosti kompleksnogo lecheniya ORVI i drugikh virusnykh infektsiy u detey v ambulatornoy praktike: otsenka znacheniya protivovirusnoy i mestnoy terapii (rezolyutsiya mezhdistsiplinarnogo soveta ekspertov) / M.S. Savenkova, E.V. Esaulenko, V.A. Petrov, i soavt. // Zhurnal infektologii. – 2025. – T. 17, No. 4. – S. 181-190. (In Russian)

30. Esaulenko E.V. Sovremennye aspekty terapii ostrykh respiratornykh virusnykh infektsiy (sistematicheskiy obzor) / E.V. Esaulenko, A.D. Ibrokhimova, M.G. Pozdnyakova, K.E. Novak // Zhurnal infektologii. – 2024. – T. 16, No. 4. – S. 23-31. (In Russian)