Symptomatic therapy of respiratory tract infections: challenges and future directions with focus on analgesics and antipyretics. A review

Respiratory tract infections are among the leading causes of morbidity and constitute a major challenge for global health care systems. Their epidemiological significance is underscored by high prevalence rates: acute respiratory viral infections (ARVI) occur at a frequency of 2–3 episodes per person annually, while pneumonia affects approximately 400 individuals per 100,000 population, resulting in substantial economic burdens for health care systems. This review addresses current challenges and key principles in the symptomatic management of respiratory infections. A major obstacle in patient management is the wide array of symptomatic treatments for ARVI available on the market, which often leads to suboptimal or inappropriate pharmacotherapy. The safety profile of non-steroidal anti-inflammatory drugs is examined, with particular focus on the risks of gastrointestinal bleeding, allergic reactions, and complications related to selective cyclooxygenase-2 inhibition. The review also considers the use of analgesics and antipyretics, principles of administration, adverse event analysis, and dosing considerations in adult patients. The potential of new prodrugs to improve safety by reducing direct gastric mucosal exposure is also discussed. In this context, loxoprofen, a phenylpropionic acid derivative activated in the liver and recently approved in the Russian Federation, is highlighted. Loxoprofen is indicated as an antipyretic and analgesic for the treatment of acute respiratory tract infections, including ARVI and acute bronchitis. Evidence regarding its efficacy as an antipyretic and analgesic in ARVI is presented, including comparative studies with conventional antipyretics and clinical experience in patients with community-acquired pneumonia, demonstrating rapid onset of action and favorable tolerability.