SELECTED ARTICLES FROM THE RECENT LITERATURE 2003

12/22/03

Update on pleconaril treatment of the common cold

Summary
Most "common colds" (URI) are caused by picornoviruses (Pico), particularly by the rhinovirus sub-group of the Pico. Pleconaril (Plec) is an investigational anti-viral agent which inhibits the growth of most Pico strains has shown some promise in small trials in the treatment of URI. Hayden et al of the Univ. of Virginia have reported the results of 2 large randomized double-blind placebo-controlled trials of Plec in 2096 ages <18 years, individuals with self-diagnosed URI or moderate or greater severity. They were examined, a nasal mucus specimen obtained for virus culture, and treated with Plec or placebo. In the 1363 subject in whom it was later found that Pico was present in the pre-treatment nasal mucus specimen there was a one day median reduction of illness in the Plec-treated individuals. The severity of symptoms and frequency of positive Plec cultures was also reduced significantly in the Plec treated individuals by the second day of therapy. No beneficial effects of Plec treatment were seen in the subjects whose pre-treatment nasal mucus specimen did not contain Pico viruses.

Plec was generally well tolerated although headache, nausea and diarrhea were reported more frequently by Plec-treated subjects. It is still not clear whether there is interaction of Plec with other drugs.

Reference
Clin Infect Dis 2003;36:1523-32

Editor's Comments
In addition to their frequent causal role in typical URI, Pico viruses have been incriminated by some investigators in triggering asthma, causing sinusitis, some cases of myocarditis, meningitis and neonatal sepsis. Therefore, effective anti-Pico therapy would be highly desirable. Plec has been around for at least 5 years. It has generally been found to be safe and well tolerated. However, its beneficial effects of Plec in URI are of modest degree, possibly because therapy with Plec is initiated too late when the Pico infection is already well-established. Further manipulation of the treatment schedules may be needed.
 

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