Knight V, Gilbert B E
Adv Intern Med. 1986;31:95-118.
We have described positive clinical effects of seven different anti-viral drugs in the treatment of viral respiratory diseases; three of these agents are approved for clinical use--amantadine, acyclovir, and vidarabine. Of the remaining four, the most consistent and broadest range of effect was observed with ribavirin while rimantadine was similar to amantadine in its effect. Interferon and enviroxime, under the conditions in which they were tested, showed a range of effect from moderate to no effect. A feature of the use of ribavirin was its administration by inhalation over several hour periods as a small-particle aerosol. This allowed a total dosage not much less than might have been given by other routes, but with the advantage that it was evenly deposited over the surface of the infected respiratory tract beginning within seconds of the start of treatment and reached higher concentration in nasal secretions than in serum. It may be that aerosol administration can be used with other drugs, as suggested by preliminary results with amantadine. We regard the results presented in this chapter as very encouraging, but just a beginning. Effective therapy will set in motion a reexamination of many problems of viral respiratory tract infection, including how to develop more rapid and more precise viral diagnosis, the need for further characterization of both short- and long-term consequences of infection in the untreated host and their modification by treatment. The structure for rapid progress in treatment of viral diseases is in place, and with it should come a resolution of many long-standing problems in this area of medicine.
我们已经描述了七种不同抗病毒药物在治疗病毒性呼吸道疾病中的积极临床效果；其中三种药物已被批准用于临床——金刚烷胺、阿昔洛韦和阿糖腺苷。在其余四种药物中，利巴韦林的效果最为一致且范围最广，而金刚乙胺的效果与金刚烷胺相似。在测试条件下，干扰素和环戊鸟苷的效果从中度到无效不等。利巴韦林的一个使用特点是通过小颗粒气雾剂在数小时内进行吸入给药。这样的给药方式使得总剂量不比其他给药途径少太多，但优点是在治疗开始后数秒内就能均匀地沉积在受感染的呼吸道表面，并且在鼻分泌物中的浓度高于血清中的浓度。正如金刚烷胺的初步结果所表明的那样，气雾剂给药方式可能也适用于其他药物。我们认为本章所呈现的结果非常令人鼓舞，但这仅仅是个开始。有效的治疗将促使人们重新审视病毒性呼吸道感染的许多问题，包括如何开发更快速、更精确的病毒诊断方法，对未治疗宿主感染的短期和长期后果进行进一步特征描述的必要性以及治疗对这些后果的改变。治疗病毒性疾病快速进展的架构已经就位，随之而来的应该是解决该医学领域许多长期存在的问题。
