Management of acute upper respiratory tract infection: the role of early intervention.

INTRODUCTION: Upper respiratory tract infection (URTI) is an illness caused by an acute infection by viruses or bacteria of the nose, sinuses, pharynx, and larynx. Most URTIs are short, mild, and self-limiting, but some can lead to serious complications, resulting in heavy social and economic burden on individuals and society. AREAS COVERED: This article presents the management guidelines and consensus established through the Delphi method during an expert roundtable conducted in November 2020 and results of a targeted literature review. EXPERT OPINION: The current acute URTI management strategies aim toward symptom alleviation and prevention of URTI virus transmission. The effectiveness of these strategies is highly increased with early intervention, administered prior to the peaking of viral shedding. This reduces the chances of developing a full-blown acute URTI, decreases symptom severity, and reduces viral transmission. Mucoadhesive gel nasal sprays have shown promising results for early intervention of acute URTI. They act by creating a barrier that can trap virus particles, thereby preventing invasion of the mucosa by the virus. Additionally, they deliver broad spectrum activity that is effective against a wide variety of pathogens that cause acute URTI. Acute URTI warrants greater attention and proactive management in reducing its burden.

New Ringer's lactate gel formulation on nasal comfort and humidification / Nova formulação de Ringer lactato gel no conforto e umidificação nasal

Abstract Introduction: The use of saline irrigation for nasal washes is a well established procedure in the treatment of sinonasal inflammation and infection. In addition to saline solutions, Ringer's lactate is also an efficient option for nasal washes and humidification. Objective: To assess the comfort, humidification and tolerance regarding stinging sensation, provided by sodium chloride nasal gel at the concentrations of 4.5 mg/g and 6.0 mg/g through questionnaires answered by the patients. Methods: A total of 60 patients, 56 females, aged between 22 and 66 years old (mean age of 47) and 4 males, aged between 36 and 66 years (mean age of 49), were included in the study for a period of 17 days (±2 days) treatment. The patients were monitored by a general practitioner throughout the study period. They were instructed to apply each product in both nostrils twice a day during a 7-day period (±2 days). The patients were evaluated prior to the use of the first product at visit 0 (V0), after 7 days of treatment (±2 days) at visit 1 (V1), after 3 days of product discontinuation at visit 2 (V2) and after 7 days (±2 days) of treatment with the second product, in visit 3 (V3). Results: A significant difference (5% significance) was observed regarding comfort and stinging sensation between the two different concentrations; comfort was higher and stinging was lower with the 6.0 mg/g concentration gel. No difference in humidification was observed between the two treatments. Conclusion: Ringer's lactate at the concentration of 6.0 mg/g was superior to that at 4.5 mg/g for parameters comfort and stinging sensation. No statistical difference was observed between the two products regarding nasal humidification.

Resumo Introdução: O uso de soluções salinas para lavagem nasal está consagrado no tratamento de quadros inflamatórios e infecciosos nasossinusais. Além das soluções salinas, o ringer lactato é uma importante opção tanto para lavagem quanto para a hidratação nasal. Objetivo: Avaliar a tolerabilidade (ardência e conforto) e umidificação do produto gel nasal cloreto de sódio 4,5 mg/g em relação ao ringer lactato 6,0 mg/g, por meio de questionários respondidos pelos pacientes. Método: Foram incluídos 60 pacientes, 56 mulheres (22-66 anos; média: 47 anos) e quatro homens (36-66 anos; média: 49 anos) foram incluídos no estudo de 17 dias (± 2 dias) de tratamento. Os pacientes foram supervisionados por um clínico geral durante todo o período do estudo. Os pacientes usaram os produtos com uma borrifada em cada narina duas vezes ao dia, durante sete dias (± 2 dias). As formulações foram avaliadas antes do uso do primeiro produto na visita 0 (V0), após sete dias (± 2 dias) de tratamento na visita 1 (V1), após três dias de interrupção do primeiro tratamento na visita 2 (V2) e após sete dias (± 2 dias) de uso do segundo produto na visita 3 (V3). Resultados: Foi observada diferença significante para o conforto das vias nasais, (significância de 5%), na comparação entre os tratamentos nos atributos de conforto e ardência. O conforto das vias nasais foi superior e a ardência inferior para o gel nasal ringer lactato 6,0 mg/g em comparação ao gel cloreto de sódio 4,5 mg/g. Não foi observada diferença significante para a umidificação entre os tratamentos. Conclusão: O gel ringer lactato 6,0 mg/g foi superior ao produto gel cloreto de sódio 4,5 mg/g nos quesitos conforto e ardência. Não foi observada diferença estatisticamente significante entre os tratamentos em relação à umidificação das vias nasais.

New Ringer's lactate gel formulation on nasal comfort and humidification.

INTRODUCTION: The use of saline irrigation for nasal washes is a well established procedure in the treatment of sinonasal inflammation and infection. In addition to saline solutions, Ringer's lactate is also an efficient option for nasal washes and humidification. OBJECTIVE: To assess the comfort, humidification and tolerance regarding stinging sensation, provided by sodium chloride nasal gel at the concentrations of 4.5mg/g and 6.0mg/g through questionnaires answered by the patients. METHODS: A total of 60 patients, 56 females, aged between 22 and 66 years old (mean age of 47) and 4 males, aged between 36 and 66 years (mean age of 49), were included in the study for a period of 17 days (±2 days) treatment. The patients were monitored by a general practitioner throughout the study period. They were instructed to apply each product in both nostrils twice a day during a 7-day period (±2 days). The patients were evaluated prior to the use of the first product at visit 0 (V0), after 7 days of treatment (±2 days) at visit 1 (V1), after 3 days of product discontinuation at visit 2 (V2) and after 7 days (±2 days) of treatment with the second product, in visit 3 (V3). RESULTS: A significant difference (5% significance) was observed regarding comfort and stinging sensation between the two different concentrations; comfort was higher and stinging was lower with the 6.0mg/g concentration gel. No difference in humidification was observed between the two treatments. CONCLUSION: Ringer's lactate at the concentration of 6.0mg/g was superior to that at 4.5mg/g for parameters comfort and stinging sensation. No statistical difference was observed between the two products regarding nasal humidification.

On ciprofloxacin concentration in chronic rhinosinusitis.

OBJECTIVE: Considering that all the evidence indicates that chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are distinct entities, the aim of this study was to compare the concentrations obtained in plasma and in sinonasal mucosa with oral and nasal topical ciprofloxacin, in patients with and without nasal polyps, without evaluating the effectiveness of the use of an antibiotic. METHODS: Prospective clinical study with single-blind randomization. The population consisted of patients with chronic rhinosinusitis with eligible for endonasal surgery, over 18 years old. It took place between January 2010 and December 2014. A single preoperative dose of ciprofloxacin (oral or nasal topic- spray, gel or drops) was given and samples of plasma and nasal mucosa (inferior turbinate, middle turbinate, ethmoid and maxillary sinus) were collected prior to surgery. The plasma and mucosal ciprofloxacin concentrations were assayed with high performance liquid chromatography (HPLC) with fluorescence detection (FD). RESULTS: The oral ciprofloxacin achieved better mucosal concentrations but had a significant plasmatic expression in all patients. None of the topical formulations achieved measurable ciprofloxacin plasmatic levels. Among the topical formulations, the gel had the best mucosal results, despite the existence of polyposis.

Characterization of mucoadhesive nasal gels containing midazolam hydrochloride prepared from Linum usitatissimum L. mucilage

Nasal drug delivery systems prepared from natural materials are gaining importance in the field of pharmaceutical technology. Mucilage isolated from Linum usitatissimum L. (LUM) seeds was reported to be an effective natural mucoadhesive agent. The present study deals with a comparison of various characteristics of nasal gels containing midazolam hydrochloride (HCl) prepared from mucoadhesive agent extracted from Linum usitatissimum L. seeds and synthetic polymers like HPMC and Carbopol 934P in terms of texture profile analysis, mucoadhesive strength, and in vivo drug absorption profiles. It was observed that gels formulated with the natural mucilage showed better results than the synthetic gels in all aspects like hardness, adhesiveness, cohesiveness and mucoadhesive strength. The absolute bioavailability of midazolam hydrochloride from the natural gel was 97.55 percent whereas that of synthetic gels was 57.33 percent and 76.81 percent respectively.

Sistemas de liberação nasal preparados com produtos naturais estão ganhando importância no campo da tecnologia farmacêutica. A mucilagem isolada de sementes de Linum usitatissimum L. (LUM) mostrou-se agente mucoadesivo eficaz. O presente estudo trata da comparação de várias características de géis nasais contendo cloridrato de midazolam preparados com agente mucoadesivo extraído das sementes de Linum usitatissimum L. e com polímeros sintéticos, como HPMC e Carbopol 943P, com relação ao perfil de textura, força mucoadesiva e perfis de absorção do fármaco in vivo. Observou-se que os géis formulados com mucilagem natural apresentam melhores resultados do que os sintéticos em todos os aspectos, como dureza, adesão, coesão e força mucoadesiva. A biodisponibilidade absoluta do cloridrato de midazolam a partir do gel natural foi de 97,55 por cento, enquanto que nos géis sintéticos foi de 57,33 por cento e 76,81 por cento, respectivamente.