Interpretation of Guidelines for the Rational Use of Antiviral Drugs in Children with Respiratory Viral Infectious Diseases

doi:10.12114/j.issn.1007-9572.2021.01.208

Abstract

Abstract: Many recent studies have reported the rational use of common antiviral drugs mostly for viral infectious diseases，yet there is no study comprehensively elaborating appropriate use of such drugs for respiratory viral infectious diseases in children. In 2020，the Chinese Hospital Association，united with National Center for Children's Health，National Medical Quality Control Center Infectious Disease，National Clinical Research Center for Respiratory Disease and other academic institutions jointly formulated the "Guidelines for the Rational Use of Antiviral Drugs in Children with Respiratory Viral Infectious Diseases "，whose publication has important guiding significance for the treatment of children with respiratory viral infectious diseases. This article interprets the guideline from the aspects of diagnosis and pathogenic testing，infection control，selection and use of antiviral drugs，etc，and aims to provide help for domestic pediatric colleagues to understand the guideline.

Key words: Respiratory viral diseases, Antiviral drugs, Child, Guideline, Interpretation

摘要： 近年来，多个国内外研究相继发布了常见抗病毒药物及其合理使用范围，但多数研究只是针对病毒感染性疾病，并没有针对抗病毒药物在儿童这一类特殊人群病毒感染性呼吸道疾病中的合理应用进行综合阐述。2020年中国医院协会联合国家儿童医学中心、国家感染性疾病医疗质量控制中心、国家呼吸系统疾病临床医学研究中心等学术机构共同制订了《抗病毒药物在儿童病毒感染性呼吸道疾病中的合理应用指南》，该指南的发布对治疗儿童病毒感染性呼吸道疾病具有重要指导意义。本文从诊断和病原学检测、感染的控制、抗病毒药物的选择及使用等几方面对该指南进行解读，旨在为国内儿科同行理解该指南提供帮助。

关键词: 病毒感染性呼吸道疾病, 抗病毒药物, 儿童, 指南, 解读

HUANG Huan,ZHANG Fangxia,DUAN Miao, et al. Interpretation of Guidelines for the Rational Use of Antiviral Drugs in Children with Respiratory Viral Infectious Diseases　[J]. Chinese General Practice, 2021, 24(26): 3276-3280. DOI: 10.12114/j.issn.1007-9572.2021.01.208.
黄欢,张芳霞,段淼等. 《抗病毒药物在儿童病毒感染性呼吸道疾病中的合理应用指南》解读[J]. 中国全科医学, 2021, 24(26): 3276-3280. DOI: 10.12114/j.issn.1007-9572.2021.01.208.

References

［1］刘强，周园红，杨占秋. 病毒感染的特点与病毒性疾病的抗病毒治疗［J］. 医学新知杂志，2014，38（3）：156-158. https://d.wanfangdata.com.cn/periodical/yxxzzz201403004.
［2］刘珍，刘芯如，何春花，等. 2010—2016年中国5岁以下儿童死亡率及主要死因分析［J］. 中华预防医学杂志，2019，53（4）：411-414.
LIU Z，LIU R R，HE C H，et al. Analysis of mortality and leading causes of death in Chinese children under 5-year-old between 2010 and 2016［J］. Chinese Journal of Preventive Medicine，2019，53（4）：411-414.
［3］中国医院协会，国家儿童医学中心（北京），国家感染性疾病医疗质量控制中心，等. 抗病毒药物在儿童病毒感染性呼吸道疾病中的合理应用指南［J］. 中华实用儿科临床杂志，2020，35（19）：1441-1450. DOI：10.3760/cma.j.cn101070-20200727-01254. http://rs.yiigle.com/CN101070202019/1247944.htm.
［4］WANG Y L，ZHU F，WANG C，et al. Children hospitalized with severe COVID-19 in Wuhan［J］. Pediatr Infect Dis J，2020，39（7）：e91-94. DOI：10.1097/INF.0000000000002739.
［5］杨琴，马红玲，王卫，等. 儿童下呼吸道流感病毒感染危重症临床特征分析［J］. 中国小儿急救医学，2020，27（7）：502-506.
YANG Q，MA H L，WANG W，et al. Analysis of the clinical characteristics of lower respiratory tract infection of influenza virus-related critical illness in children［J］. Chinese Pediatric Emergency Medicine，2020，27（7）：502-506.
［6］范雪，乐原，李静. 儿童急性呼吸道感染病毒谱分析［J］. 解放军医学院学报，2018，39（11）：951-954.
FAN X，LE Y，LI J. Virus spectrum analysis of acute respiratory infection in children［J］. Academic Journal of Chinese PLA Medical School，2018，39（11）：951-954.
［7］樊慧峰，卢根，陶建平. 腺病毒肺炎合并闭塞性细支气管炎的早期识别与治疗［J］. 中国小儿急救医学，2019（10）：742-745. DOI：10.3760/cma.j.issn.1673-4912.2019.10.006. http://rs.yiigle.com/CN115454201910/1166196.htm.
［8］党亚洁，郑明睿，金先桥. 呼吸道微生物定植与感染的认识［J］. 国际呼吸杂志，2016，36（8）：628-631.
DANG Y J，ZHENG M R，JIN X Q. Airway microbial colonization and infection［J］. International Journal of Respiration，2016，36（8）：628-631.
［9］楊木春. 手足口病的流行过程和预防控制思考［J］. 中西医结合心血管病电子杂志，2019，7（6）：23. http://www.cnki.com.cn/Article/CJFDTotal-ZXJH201906016.htm.
［10］吉小丽. 抗病毒药物在我院儿科住院患者中的使用调查［J］. 海峡药学，2020，32（5）：212-214. http://www.cnki.com.cn/Article/CJFDTotal-HAIχ202005094.htm.
［11］黄贝茹，黄钢花.2016—2017年我国儿童药品不良反应分析［J］. 中国新药杂志，2019，28（6）：758-762.
HUANG B R，HUANG G H．Analysis of adverse drug reactions in children from 2016 to 2017［J］. Chinese Journal of New Drugs，2019，28（6）：758-762.
［12］杨林勇,刘新社,萧伟,等．我国常见儿童药物不良反应及对策研究［J］. 中国中药杂志，2016，41（14）：2743-2747.
YANG L Y, LIU X S, XIAO W, et al. Study on common adverse drug reactions of children in my country and countermeasures［J］. China Journal of Chinese Materia Medica，2016，41（14）：2743-2747.
［13］王晓玲．儿科呼吸系统药物临床综合评价的方法学建议［J］. 中国实用儿科杂志，2020，35（3）：195-198.
WANG X L．Methodological Suggestions for Clinical Comprehensive Evaluation of Pediatric Respiratory Drugs［J］. Chin J Prac Pediatr，2020，35（3）：195-198.
［14］DE WEERD N A，NGUYEN T. The interferons and their receptors——distribution and regulation［J］. Immunol Cell Biol，2012，90（5）：483-491. DOI：10.1038/icb.2012.9.
［15］MCNAB F，MAYER-BARBER K，SHER A，et al. Type I interferons in infectious disease［J］. Nat Rev Immunol，2015，15（2）：87-103. DOI：10.1038/nri3787.
［16］赵德育，刘红霞，刘峰，等. 雾化吸入重组人干扰素α2b治疗小儿毛细支气管炎有效性和安全性的随机对照多中心研究［J］. 中华实用儿科临床杂志，2016，31（14）：1095-1100.
ZHAO D Y，LIU H X，LIU F，et al. Multicenter and random clinical study on efficacy and safety of atomization inhalation recombinant human interferon α2b in treatment of children with bronchiolitis［J］. Chinese Journal of Applied Clinical Pediatrics，2016，31（14）：1095-1100.
［17］徐东，许华平，胡俊杰，等. 雾化吸入重组人干扰素α-2b治疗婴幼儿毛细支气管炎的多中心研究［J］. 中国妇幼保健，2016，31（22）：4770-4771. https://d.wanfangdata.com.cn/periodical/zgfybj201622064.
［18］申昆玲，尚云晓，张贺，等. 重组人干扰素α2b喷雾剂（假单胞菌）治疗儿童急性上呼吸道感染有效性和安全性多中心随机对照临床研究［J］. 中国实用儿科杂志，2019，34（12）：1010-1016. DOI：10.19538/j.ek2019120610.
SHEN K L，SHANG Y X，ZHANG H，et al. A multicenter，randomised，controlled clinical study on efficacy and safety of recombinant human interferon α 2b spray（P.putida）in treatment of acute upper respiratory tract infection in children［J］. Chinese Journal of Practical Pediatrics，2019，34（12）：1010-1016. DOI：10.19538/j.ek2019120610.
［19］姚婷新，廖亦男，谷芬，等. 重组人干扰素α-2b喷雾剂治疗疱疹性咽峡炎患儿疗效观察［J］. 中国中西医结合儿科学，2017，9（5）：427-429. DOI：10.3969/j.issn.1674-3865.2017.05.020.
YAO T X，LIAO Y N，GU F，et al. Clinical effect of recombinant human interferon α-2 bspray on herpangina in children［J］. Chinese Pediatrics of Integrated Traditional and Western Medicine，2017，9（5）：427-429. DOI：10.3969/j.issn.1674-3865.2017.05.020.
［20］徐艳利，李颖，陈益平，等. 重组人干扰素α2b喷雾剂治疗小儿手足口病有效性和安全性的多中心对照临床研究［J］. 中华传染病杂志，2018，36（2）：101-106.
XU Y L，LI Y，CHEN Y P，et al. A multicenter controlled clinical study on the efficacy and safety of recombinant human interferon α2b spray in the treatment of hand，foot and mouth disease in children［J］. Chinese Journal of Infectious Diseases，2018，36（2）：101-106.
［21］宋杲，成梦群，魏贤文. 新型冠状病毒（2019-nCoV）治疗药物体内外研究及药物研发进展［J］. 病毒学报，2020，36（2）：300-305. DOI：10.13242/j.cnki.bingduxuebao.003646.
SONG G，CHENG M Q，WEI X W. Guidelines for the rational use of antiviral drugs in children with respiratory viral infectious diseases ［J］. Chinese Journal of Virology，2020，36（2）：300-305. DOI：10.13242/j.cnki.bingduxuebao.003646.
［22］陈岷，童荣生，边原，等. 皮下注射α-干扰素治疗2019年新型冠状病毒肺炎的循证快速评估［J］. 医药导报，2020，39（4）：483-488.
CHEN M，TONG R S，BIAN Y，et al. Evidence-based rapid review on possibility of treatment of novel coronavirus pneumonia with subcutaneous interferon-α［J］. Herald of Medicine，2020，39（4）：483-488.
［23］国家卫生健康委员会，国家中医药管理局. 新型冠状病毒肺炎诊疗方案（试行第八版）［J］. 传染病信息，2020，33（4）：289-296.
National Health Commission of the PRC，National Administration of Traditional Chinese Medicine. Guideline on diagnosis and treatment of novel coronavirus pneumonia（interim 8th edition）［J］. Infectious Disease Information，2020，33（4）：289-296.
［24］申昆玲，尚云晓，张国成，等. α干扰素在儿科临床合理应用专家共识［J］. 中华实用儿科临床杂志，2018，33（17）：1301-1308.
SHEN K L，SHANG Y X，ZHANG G C，et al. Expert consensus on the rational application of interferon alpha in pediatrics［J］. Chinese Journal of Applied Clinical Pediatrics，2018，33（17）：1301-1308.
［25］方学平，梅兴国. 呼吸道合胞病毒化学治疗药物的研究进展［J］. 国外医学（药学分册），2005，32（2）：115-119. https://d.wanfangdata.com.cn/periodical/gwyx-yxfc200502012.
［26］张舒一. 流行性出血热通过利巴韦林注射液治疗的效果分析［J］. 中国继续医学教育，2015，7（23）：159-160. DOI：10.3969/j.issn.1674-9308.2015.23.116.
ZHANG S Y. Analysis effect of ribavirin injection treatment epidemic hemorrhagic fever［J］. China Continuing Medical Education，2015，7（23）：159-160. DOI：10.3969/j.issn.1674-9308.2015.23.116.
［27］冯穗芬，魏毅. 利巴韦林在抗新型冠状病毒感染使用中的新观点［J］. 临床药物治疗杂志，2020，18（2）：43-45. DOI：10.3969/j.issn.1672-3384.2020.02.009.
FENG S F，WEI Y. The new ideas for potential use of ribavirin in treatment of Corona virus disease 2019［J］. Clinical Medication Journal，2020，18（2）：43-45. DOI：10.3969/j.issn.1672-3384.2020.02.009.
［28］国家卫生健康委办公厅，国家中医药管理局办公室.新型冠状病毒肺炎诊疗方案（试行第七版）［EB/OL］.（2020-03-04）［2021-02-12］. http://www.nhc.gov.cn/xcs/zhengcwj/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml.
［29］余彦亮，张小兰，邹新英.奥司他韦联合干扰素雾化治疗儿童流行性感冒的临床效果分析［J］. 中国实用医药，2017，12（8）：129-130. https://d.wanfangdata.com.cn/periodical/zgsyyy201708063.
［30］国家卫生健康委员会，国家中医药管理局. 新型冠状病毒感染的肺炎诊疗方案（试行第五版）［EB/OL］. （2020-02-21）［2021-03-04］. http://www.nhc.gov.cn/yzygj/s7653p/202002/3b09b894ac9b4204a79db5b8912d4440/files/7260301a393845fc87fcf6dd52965ecb.pdf.
［31］李铁钢，王鸣. 在抗击新型冠状病毒肺炎疫情同时警惕季节性流感的叠加效应［J］. 中华预防医学杂志，2020，54（4）：337-339.
［32］单慧，王倩，张雪媛，等. 盐酸阿比多尔临床药理学综述［J］. 中国感染与化疗杂志，2020，20（3）：340-344.
SHAN H，WANG Q，ZHANG X Y，et al. Review of clinical pharmacology of abidol hydrochloride［J］. Chinese Journal of Infection and Chemotherapy，2020，20（3）：340-344.
［33］臧杰，彭夫松，姜尧，等. 阿比多尔治疗普通型新型冠状病毒肺炎的疗效及安全性分析［J］. 临床药物治疗杂志，2020，18（4）：26-29.
ZANG J，PENG F S，JIANG Y，et al. Retrospective clinical study of efficacy and safety of arbidol hydrochloride in the treatment of Corona virus disease 2019 with common type［J］. Clinical Medication Journal，2020，18（4）：26-29.
［34］国务院应对新型冠状病毒感染的肺炎疫情联防联控机制. 关于做好儿童和孕产妇新型冠状病毒感染的肺炎疫情防控工作的通知［J］. 中华人民共和国国家卫生健康委员会公报，2020（2）：8-10. https://kns.cnki.net/KCMS/detail/detail.aspx?filename=WSGB202002004&dbname=CJFD&dbcode=CJFQ．
［15］GREENSTONE M，HACK M. Obstructive sleep apnea［J］．BMJ，2014，348：g3745．DOI：10.1136/bmj.g3745.
［16］THOMAS R J，MIETUS J E，PENG C K，et al．An electrocardiogram-based technique to assess cardiopulmonary coupling during sleep［J］．Sleep，2005，28（9）：1151-1161．DOI：10.1093/sleep/28.9.1151.
［17］SCHRAMM P J，THOMAS R，FEIGE B，et al．Quantitative measurement of sleep quality using cardiopulmonary coupling analysis：a retrospective comparison of individuals with and without primary insomnia［J］．Sleep Breath，2013，17（2）：713-721．DOI：10.1007/s11325-012-0747-6.
［18］谢敏，雷飞，郭丹，等．心肺耦合分析技术对阻塞性睡眠呼吸暂停的诊断价值［J］．中华医学杂志，2018，98（20）：1565-1569．DOI：10.3760/cma.j.issn.0376-2491.2018.20.007.
XIE M，LEI F，GUO D，et al．Diagnosis of obstnlctive sleep apnea using cardiopulmonary copling analysis［J］．National Medical Journal of China，2018，98（20）：1565-1569．DOI：10.3760/cma.j.issn.0376-2491.2018.20.007.
［19］冯晶，吴惠涓，王宗文，等．心肺耦合技术与多导睡眠图对睡眠呼吸事件判读的一致性分析［J］．中华神经科杂志，2017，50（8）：606-612．DOI：10.3760/cma.j.issn.1006-7876.2017.08.009.
FENG J，WU H J，WANG Z W，et al．Correlation analysis of two difficult techniques for the score of sleep breathing events：cardiopulmonary coupling vs polysomnography［J］．Chinese Journal of Neurology，2017，50（8）：606-612．DOI：10.3760/cma.j.issn.1006-7876.2017.08.009.
［20］AZAGRA-CALERO E，ESPINAR-ESCALONA E，BARRERA-MORA J M，et al．Obstructive sleep apnea syndrome（OSAS）.Review of the literature［J］．Med Oral Patol Oral Cir Bucal，2012，17（6）：e925-929．DOI：10.4317/medoral.17706.
［21］LI A M，SO H K，AU C T，et al．Epidemiology of obstructive sleep apnoea syndrome in Chinese children：a two-phase community study［J］．Thorax，2010，65（11）：991-997．DOI：10.1136/thx.2010.134858.
［22］BELGü A U，ERDOGAN B，SAN T，et al．The relationship between AHI，Epworth scores and sleep endoscopy in patients with OSAS［J］．Eur Arch Otorhinolaryngol，2015，272（1）：241-245．DOI：10.1007/s00405-014-3220-2.
［23］洪玲玲，邢璐，孙启蒙，等．抑郁症共病阻塞性睡眠呼吸暂停患者主–客观睡眠状况分析［J］．深圳中西医结合杂志，2020，30（8）：4-6．DOI：10.16458/j.cnki.1007-0893.2020.08.002.
HONG L L，XING L，SUN Q M，et al．The comparison of subjective and objective sleep status in obstructive sleep apnea patients with depression ［J］．Shenzhen Journal of Integrated Traditional Chinese and Western Medicine，2020，30（8）：4-6．DOI：10.16458/j.cnki.1007-0893.2020.08.002.
［24］MAGNUSDOTTIR S，HILMISSON H. Ambulatory screening tool for sleep apnea：analyzing a single-lead electrocardiogram signal（ECG）［J］．Sleep Breath，2018；22（2）：421-429．DOI：10.1007/s11325-017-1566-6.
［25］GECKIL A A，ERMIS H. The relationship between anxiety，depression，daytime sleepiness in the REM-related mild OSAS and the NREM-related mild OSAS［J］．Sleep Breath，2020，24（1）：71-75．DOI：10.1007/s11325-019-01838-y.
［26］HABUKAWA M，UCHIMURA N，KAKUMA T，et al．Effect of CPAP treatment on residual depressive symptoms in patients with major depression and coexisting sleep apnea：contribution of daytime sleepiness to residual depressive symptoms［J］．Sleep Med，2010；11（6）：552-557．DOI：10.1016/j.sleep.2010.02.007.

[1]	CHAI Zhihao, ZHANG Weisen, LUO Jiaoling, ZHU Feng, ZHU Tong, JIN Yali, PAN Jing, LU Yingjun, JIANG Chaoqiang. The Mediation Effect of Socioeconomic Status in Childhood Parental Literacy and Cognitive Function in Middle-aged and Older People: Based on Guangzhou Biobank Cohort Study [J]. Chinese General Practice, 2026, 29(21): 2959-2966.
[2]	CHEN Dian, LONG Huanyu, CHU Lanhe, JIANG Yixia, GUO Wanjin, NIU Yang, CHEN Yahong. Interpretation of Global Strategy for the Diagnosis, Treatment, Management and Prevention of Chronic Obstructive Pulmonary Disease 2026 Report [J]. Chinese General Practice, 2026, 29(21): 2913-2932.
[3]	HUANG Haili, LI Yuhong, YU Yang, GUO Ping, HAN Changzheng, LIU Ping. A Mixed Study of Fertility Intention and Its Influencing Factors among the Childbearing-age Women in Anhui Province [J]. Chinese General Practice, 2026, 29(20): 2887-2894.
[4]	CHEN Xiangyang, HUANG Hongmei, LI Sheyu. Prevention and Management of Adult Obesity: Progress and Trends from Six Keywords in 2025 [J]. Chinese General Practice, 2026, 29(20): 2753-2758.
[5]	HEI Moran, MA Hui'e, XU Zecheng, YAN Shiyan, LI Ziyan, YANG Yi, JIN Jun, CHEN Zelin, GUO Yi, ZHAO Xue, ZHAO Tianyi. Comparison, Analysis and Considerations of Methods for Determining Clinical Questions in Domestic and International Clinical Practice Guideline Development Manuals [J]. Chinese General Practice, 2026, 29(18): 2554-2560.
[6]	FAN Meixiang, YAN Yunyun, HUANG Yanyan. Interpretation and Discussion of Guidelines for Preventive Activities in General Practice: Bladder Cancer [J]. Chinese General Practice, 2026, 29(18): 2450-2453.
[7]	TONG Min, WANG Ying, XU Yanshen, ZENG Yongjian, WEN Hua, LIU Xue, SUN Xiangjuan, ZHANG Fenghua. Functional Dyspepsia Guideline Quality Assessment: Based on AGREE Ⅱ and RIGHT Tools [J]. Chinese General Practice, 2026, 29(17): 2410-2417.
[8]	WANG Yibo, HE Kaiyu, LIANG Guofen, YANG Zhenhua, ZHAO Tingxian, LIAO Biyi, ZHANG La, LIU Shiwei, GONG Xuezhong, LIU Xusheng, GU Yueyu, QIN Xindong, SU Guobin. Diagnosis and Management of Recurrent Urinary Tract Infections in Women: a Comparison and Interpretation Based on Existing Guidelines and Evidence [J]. Chinese General Practice, 2026, 29(17): 2387-2399.
[9]	MENG Zixi, ZHAO Huiduo, LIU Ruidong, WANG Beibei, JIANG Mingqiang, CHENG Xufeng. Guidelines for Diagnosis and Treatment of Acute Mastitis with Integrated Traditional Chinese and Western Medicine [J]. Chinese General Practice, 2026, 29(17): 2273-2281.
[10]	Chinese Nutrition Society Obesity Prevention and Control Branch. Chinese Guidelines for Behavioral and Lifestyle Interventions for Obesity [J]. Chinese General Practice, 2026, 29(16): 2113-2139.
[11]	GUO Jiao, ZHANG Gaojing, LIU Xincan. Quality Evaluation of TCM Clinical Practice Guidelines/Consensus: Based on Two Guideline Evaluation Tools [J]. Chinese General Practice, 2026, 29(15): 2100-2106.
[12]	LIU Xiaoyu, ZHU Rongxin, ZHANG Bo, SU Hang, REN Xianqing. Defining Clinical Questions and Outcome Indicators in Guidelines for Diagnosis and Treatment of Nocturnal Enuresis in Children with Integrated Traditional Chinese and Western Medicine Based on Modified Delphi Method [J]. Chinese General Practice, 2026, 29(15): 2050-2055.
[13]	XIONG Xiaoman, LI Aijun, ZHENG Yuehong, YANG Qiuyan, ZHANG Yanli. To Explore the Necessity of Bronchodilation Test in Children with Normal FEV₁, FVC and FEV₁/FVC but Decreased Small Airway Function [J]. Chinese General Practice, 2026, 29(15): 1992-1997.
[14]	Nephrology Branch of China Association of Chinese Medicine, Nephrology Committee of Guangdong Provincial Association of Chinese Medicine, SU Peiling, YANG Lihong, BAO Kun. Diagnosis and Treatment Guideline of Integrated Traditional Chinese and Western Medicine for Idiopathic Membranous Nephropathy (2025) [J]. Chinese General Practice, 2026, 29(15): 1953-1970.
[15]	ZHANG Qiang, ZHAO Wenxia, WANG Ziyi, YAN Le, LIANG Haowei, WANG Jinfan, FANG Jinhua, LU Cuncun. Interpretation of the Reporting Guideline for Systematic Reviews of Outcome Measurement Instruments (PRISMA-COSMIN for OMIs 2024) [J]. Chinese General Practice, 2026, 29(13): 1766-1775.