Please say no to ribavirin!

April to July every year is the season of hand-foot-mouth disease and the season of high incidence of herpetic angina. Many parents bring their children to see a doctor.

One of the questions parents often ask is whether ribavirin can be taken orally for treatment. They even say that some pharmacy staff or kindergarten teachers told them that ribavirin spray can be used to treat skin herpes in throat, hands, feet and buttocks.

Not only that, the child caught a cold, and many parents’ first reaction was [give the child some antiviral drugs-then ribavirin]!

It seems that ribavirin has become a golden signboard for the treatment of various viral infectious diseases.

However, do ribavirin really need to be used in these situations?

What kind of magic medicine is ribavirin?

Ribavirin, also known as [triazole nucleoside], is an antiviral drug, also known as [ribavirin] in China, which is said to be able to resist many kinds of viruses.

Moreover, many people do regard it as a [universal] antiviral drug.

After successful imitation in the 1970s, ribavirin has been sold in more than 10 dosage forms in China, including tablets, injections, granules, sprays, buccal tablets, etc.

However, the mechanism of ribavirin has not been clearly studied.

Only in vitro cell culture tests show that ribavirin has selective inhibitory effect on [respiratory syncytial virus], but the clinical effect is uncertain.

Therefore, the current specification mentions [only applicable to viral pneumonia, bronchitis and cutaneous herpes virus infection caused by “respiratory syncytial virus” (the name of a virus, referred to as RSV)].

The Pediatric Bible < < Nielsen Pediatrics > > (20th Edition) describes ribavirin as follows:

    Although intravenous ribavirin is highly effective in treating Lhasa fever or other hemorrhagic fevers, But it has not been allowed in the United States. In the United States, Ribavirin is only authorized for aerosol inhalation to treat respiratory syncytial virus infection, And oral preparations combined with interferon in the treatment of hepatitis C… The strict indications for nebulizing ribavirin are: infants with low immune function or other high-risk factors (such as children with chronic pulmonary diseases or cyanotic congenital heart diseases), patients with severe RSV lower respiratory diseases…

The side effects of ribavirin cannot be underestimated.

You said that ribavirin is neither harmful nor beneficial. If it is used, it should only make parents feel at ease. However, its side effects that cannot be ignored have forced me to stand up and tell everyone that this medicine cannot be used casually.

1. Hemolytic anemia

The main toxicity of ribavirin is hemolytic anemia.

Specifically, patients may experience hemoglobin decline within the first 1-2 weeks after oral treatment, of which about 10% may be accompanied by cardiopulmonary side effects.

There have been reports that ribavirin can cause myocardial damage to anemia patients, some of which are fatal, so ribavirin cannot be used for patients with a history of heart disease or obvious heart disease symptoms.

Therefore, hemoglobin should be monitored frequently before, after and during ribavirin treatment.

2. Teratogenicity and carcinogenicity

Although there is no authoritative research conclusion on the teratogenicity and carcinogenicity of ribavirin to human beings, However, WHO has a 19-year monitoring report on adverse drug reactions, which shows that of the 6,649 reports that may be caused by ribavirin, 52 are tumors and 96 are fetal abnormalities, which is really not a small proportion. Moreover, animal experiments show that ribavirin has obvious teratogenicity and carcinogenicity.

Therefore, ribavirin is prohibited for pregnant and nursing women. In addition, both men and women taking this product should use contraception before, during and at least six months after treatment.

Is ribavirin useful for hand-foot-mouth disease/herpetic angina?

As we said earlier, the only definite therapeutic effect of ribavirin is against [respiratory syncytial virus]. As for the hundreds of other viruses that cause symptoms, there is actually no clinical evidence to prove the therapeutic effect of ribavirin, so many viruses are not included in the indications.

Therefore, if the baby catches a cold or suspects hand-foot-mouth disease, there is really no need to use ribavirin eagerly.

After all, in both cases, it is too unlikely to happen to be [respiratory syncytial virus], and this drug has so many side effects.

So, is there any drug that can treat hand-foot-mouth disease and herpetic angina?

Hand-foot-mouth disease and herpetic angina are very common in children under 6 years old. Various enteroviruses may cause these two diseases, and the vast majority of children have very mild symptoms.

Unfortunately, for these two diseases, there is currently no targeted treatment of drugs, even if the symptoms are serious, doctors can only symptomatic treatment, such as fever is antipyretic, diarrhea is fluid replacement, at the same time strengthen nursing. Generally speaking, children can heal themselves in 1 ~ 2 weeks. As for antiviral treatment, there is really no recommendation at present.

Herpetic angina rarely appears severe, but EV71 virus caused by hand-foot-mouth disease some will develop into severe, myocarditis, meningitis and other serious conditions. Vaccines have been developed for EV71 virus, but many places in China cannot be vaccinated, so at present only passive treatment can be continued and cannot be actively defended.

Ribavirin is useless to deal with colds!

The common cold is mainly caused by virus infection and is a self-limited disease. Even if it is not treated, it will generally be cured in about one week. Therefore, the common cold is mainly symptomatic treatment, such as relieving nasal obstruction, runny nose, cough and other symptoms, making children feel less uncomfortable.

However, these treatments cannot prevent the disease from worsening or make the cold recover faster. They can only make the baby feel better.

The “Expert Consensus on Standardized Diagnosis and Treatment of the Common Cold” released in 2012 clearly points out: [At present, there is no specific antiviral drug specifically for the common cold, and the common cold does not need to be treated with antiviral drugs. Excessive use of antiviral drugs has significantly increased the risk of related adverse reactions].

See? There is no shadow of Ribavirin.

Ribavirin, you can’t use it if you want.

In short, ribavirin is not an antiviral drug.

In foreign countries, ribavirin is only used to treat respiratory syncytial virus infection (and indications are strictly controlled) and hepatitis C. Attention should be paid to monitoring the possibility of side effects such as anemia, heart and lung, carcinogenicity, etc. During use, ribavirin is by no means a magic drug that can be used for treatment or even prevention if virus infection is suspected.

However, in China, some doctors have used it as a universal broad-spectrum antiviral drug, which is widely used in children suffering from self-limited diseases such as hand-foot-mouth disease, herpetic angina, common cold, etc. It is really intolerable.

Mothers, the next time your child catches a cold or suspects hand-foot-mouth disease, please bypass this medicine decisively: the existing authoritative data all tell us that it is an embroidered pillow and may have various side effects, so ribavirin really cannot be used casually!