Russia’s Health Ministry has published a new version of its clinical guidelines for treating acute respiratory viral infections in adults. The previous update was issued in 2021. The revised document now divides medicines into first-line and second-line treatments.
First-line drugs include the direct antivirals riamilovir, umifenovir, and enisamium iodide. The document says they should be prescribed within 48 hours of symptom onset to stop viral replication. A doctor interviewed by the publication said these medications do not have convincingly proven effectiveness or safety. He added that umifenovir, best known as the active ingredient in Arbidol, has shown activity in laboratory settings, but not in clinical trials involving humans.
The doctor also said that, in his view, only oseltamivir currently has proven antiviral properties, and that it is used for influenza. For other viral respiratory infections, he said, treatment is generally limited to symptom relief such as fluids, nasal drops, and fever-reducing medication when needed.
The ministry placed immunotropic drugs with indirect antiviral effects in the second-line category, including interferons, immunomodulators, and general tonics. Among them is azoximer bromide (Polyoxidonium), which the article says has an evidence rating of C5, meaning the recommendation is based on expert opinion rather than clinical trials. According to the report, tilorone, oxyethylammonium methylphenoxyacetate, and imidazolyl ethanamide pentanedioic acid received the same low rating. The new version dropped Kagocel but added meglumine acridone acetate, Ergoferon, and Rafamin.
The revisions also affect diagnostics. Patients with ARVI symptoms are now recommended to receive a rapid test using a nasopharyngeal swab, which can detect influenza A and B, respiratory syncytial virus, adenovirus, and SARS-CoV-2 within 10 to 15 minutes. Previously, such testing was recommended only under specific conditions, such as severe illness, older age, or outbreak settings.
In addition, patients with severe ARVI are now supposed to undergo a biochemical blood test to help identify complications in time. Earlier guidelines provided only for general blood and urine tests, which remain in the updated version as well. According to a general practitioner cited in the article, biochemical testing can assess liver, kidney, and pancreatic function and also measure C-reactive protein as an inflammatory marker.