Strategy of Rational Therapy of Acute Respiratory Infections in Patients with Comorbidity

Abstract. The paper discusses specific features of acute respiratory infections (ARI) progression in patients with comorbidity. The relevance of this study is accounted for by severe progression of ARIs in this group of patients, as well as by specific considerations of combining causal treatment of infections with life-long treatment of chronic diseases.

The aim of the study was to use a clinical case to substantiate an optimal treatment strategy for influenza and associated complications in a comorbid patient.

Results: the analysis of the clinical case showed that an unfavourable course of ARI in the patient was due to the lack of timely antiviral therapy, adverse effects of paracetamol during statin therapy, exposure to pneumonia pathogen degradation products, general intoxication, and immune response. The compromised medical history contributed to the development of severe complications. The paper proposes a strategy for selecting the most eff ective and safe approach to the treatment of ARIs in a comorbid patient.

Conclusions: ARIs in patients with chronic diseases entail increased risks of complications that may arise both due to specific characteristics of the infection and unfavourable combination of drugs. Treatment regimens for infl uenza and other ARIs in comorbid patients should be eff ective and timely. Early antiviral treatment is especially important in patients with comorbidity. When choosing a treatment regimen, it is necessary to assess potential benefi ts of pharmacotherapy as well as associated risks, including those related to previously prescribed medicines. 

1. Pearce DC, McCaw JM, McVernon J, Mathews JD. Influenza as a trigger for cardiovascular disease: an investigation of serotype, subtype and geographic location. Environ Res. 2017;156:688–96. https://doi.org/10.1016/j.envres.2017.04.024

2. Han J, Mou Y, Yan D, Zhang YT, Jiang TA, Zhang YY, et al. Transient cardiac injury during H7N9 infection. Eur J Clin Invest. 2015;45(2):117–25. https://doi.org/10.1111/eci.12386

3. Deng LH, Zeng YL, Feng P, Liu YL, Wang LC, Bai Y, et al. Clinical characteristics of critical patients with pandemic influenza A (H1N1) virus infection in Chengdu, China. J Zhejiang Univ Sci B. 2012;13(1):49–55. https://doi.org/10.1631/jzus.B1100168

4. Dong M, Liu T, Li G. Association between acute infections and risk of acute coronary syndrome: a meta-analysis. Int J Cardiol. 2011;147(3):479–82. https://doi.org/10.1016/j.ij card.2011.01.035

5. Wiegand JA, Torgersen C, Bloechlinger S, Takala J, Dünser MW. Influenza A(H1N1) infection and severe cardiac dysfunction in adults: a case series. Wien Klin Wochenschr. 2011;123(3–4):120–3. https://doi.org/10.1007/s00508-010-1520-0

6. Tseng GS, Hsieh CY, Hsu CT, Lin JC, Chan JS. Myopericarditis and exertional rhabdomyolysis following an influenza A (H3N2) infection. BMC Infect Dis. 2013;13:283. https://doi.org/10.1186/1471-2334-13-283

7. Nguyen JL, Yang W, Ito K, Matte TD, Shaman J, Kinney PL. Seasonal influenza infections and cardiovascular disease mortality. JAMA Cardiol. 2016;1(3):274–81. https://doi.org/10.1001/jamacardio.2016.0433

8. Patel AM, Shariff S, Bailey DG, Juurlink DN, Gandhi S, Mamdani M, et al. Statin toxicity from macrolide antibiotic coprescription: a population-based cohort study. Ann Intern Med. 2013;158(12):869–76. https://doi.org/10.7326/0003-4819-158-12-201306180-00004

9. Pinson GM, Beall JW, Kyle JA. A review of warfarin dosing with concurrent acetaminophen therapy. J Pharm Pract. 2013;26(5):518–21. https://doi.org/10.1177/0897190013488802

10. Fanelli A, Ghisi D, Aprile PL, Lapi F. Cardiovascular and cerebrovascular risk with nonsteroidal anti-inflammatory drugs and cyclooxygenase 2 inhibitors: latest evidence and clinical implications. Ther Adv Drug Saf. 2017;8(6):173–82. https://doi.org/10.1177/2042098617690485

11. Antithrombotic Trialists’ Collaboration. Collaborative metaanalysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324(7329):71–86. https://doi.org/10.1136/bmj.324.7329.71

12. Rafalskij VV, Krikova AV, Baglikov AN. Clinical pharmacology of acetylsalicylic acid as an anti-thrombotic agent. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2009;8(7):102–7 (In Russ.)

13. Wen YC, Hsiao FY, Lin ZF, Fang CC, Shen LJ. Risk of stroke associated with use of nonsteroidal anti-inflammatory drugs during acute respiratory infection episode. Pharmacoepidemiol Drug Saf. 2018;27(6):645–51. https://doi.org/10.1002/pds.4428

14. Dekhnich АV, Hachatryan NN. New and old oxazolidinones: tedizolid vs. linezolid. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya = Clinical Microbiology and Antimicrobial Chemotherapy. 2017;19(2):121–9 (In Russ.)

15. Ruzhentsova TA, Ploskireva AA, Aleshina NI, Astrina OS, Meshkova NA, Ivanova LA, et al. Increasing treatment efficacy in children with acute respiratory viral infections. Infektsionnye bolezni = Infectious Diseases. 2019;17(2):46–52 (In Russ.) https://doi.org/10.20953/1729-9225-2019-2-46-52

16. Tikhonova EP, Kuzmina TY, Andronova NV, Tyushevskaya OA, Elistratova TA, Kuzmin AE. Study of eff ectiveness of antiviral drugs (umifenovir, triazavirin) against acute respiratory viral infections. Kazanskiy meditsinskiy zhurnal = Kazan Medical Journal. 2018;99(2):215–23 (In Russ.) тhttps://doi.org/10.17816/KMJ2018-215

17. Tokin II, Tsvetkov VV, Golobokov GS. Comparative clinical and economic evaluation of two alternative antiviral therapy regimens for influenza patients. Zhurnal infektologii = Journal Infectology. 2018;10(2):110–6 (In Russ.) https://doi.org/10.22625/2072-6732-2018-10-2-110-116

18. Rafalsky V, Averyanov A, Bart B, Minina E, Putilovskiy M, Andrianova E, et al. Efficacy and safety of Ergoferon versus oseltamivir in adult outpatients with seasonal influenza virus infection: a multicenter, open-label, randomized trial. Int J Infect Dis. 2016;51:47–55. https://doi.org/10.1016/j.ijid.2016.09.002

19. Arabi H, Zaid AA, Alreefi M, Alahmed S. Suspected Oseltamivirinduced bradycardia in a pediatric patient: a case report from King Abdullah Specialist Children’s Hospital, Riyadh, Saudi Arabia. Clin Pract. 2018;8(4):1094. https://doi.org/10.4081/cp.2018.1094

20. Wells Q, Hardin B, Raj SR, Darbar D. Sotalol-induced torsades de pointes precipitated during treatment with oseltamivir for H1N1 influenza. Heart Rhythm. 2010;7(10):1454–7. https://doi.org/10.1016/j.hrthm.2010.07.025

21. Wagner J, Abdel-Rahman SM. Oseltamivir-warfarin interaction in hypoplastic left heart syndrome: case report and review. Pediatrics. 2015;135(5):e1333–6. https://doi.org/10.1542/peds.2014-2578

22. Shah SP, Patel KM, Subedi R, Gambhir HS. Review of potential drug interaction between Oseltamivir and Warfarin and why it is important for emergency medicine physicians. Am J Emerg Med. 2017;35(8):1207.e3–4. https://doi.org/10.1016/j.ajem.2017.03.040

23.