Table 1 Summary table of antiviral drugs

Broad-spectrum antiviral drugs

Ribavirin

Inhibits viral RNA polymerase, reduces intracellular GTP production, interferes with viral RNA and protein synthesis

Pneumonia caused by Respiratory Syncytial Virus (RSV)

Nebulization: 20 mg/mL, three times daily for 3–7 days; Oral: 600–800 mg, twice daily

Broad-spectrum antiviral activity against both RNA and DNA viruses Significant efficacy against RSV infections Can be administered via nebulization, suitable for children and critically ill patients

Dose-dependent anemia Teratogenic effects; contraindicated in pregnant women Long-term use may lead to viral resistance

Dose-dependent anemia, teratogenic effects, long-term use may lead to viral resistance

[20,21,22,23,24]

Arbidol

Binds to viral hemagglutinin, prevents viral fusion with host cells, has immunostimulatory effects

Influenza and other respiratory viral infections

Oral: 200 mg, twice daily for 5–7 days

Broad-spectrum antiviral activity against multiple viruses Has immune-enhancing effects, boosting host resistance Convenient oral administration

Efficacy depends on early intervention May be affected by viral resistance or mutations Limited clinical evidence

Efficacy depends on early intervention, may be limited by viral resistance or mutation

[26,27,28,29,30,31]

Antiherpetic drugs

Acyclovir

Converts to the active form acyclovir triphosphate, competitively inhibits viral DNA polymerase, terminates viral DNA chain synthesis

Herpes Simplex Virus (HSV), Varicella-Zoster Virus (VZV) infections

Oral: 200 mg, every 4 h; Intravenous: adjusted based on patient condition

Significant efficacy against HSV and VZV infections Available as both oral and intravenous formulations Widely used in clinical practice with ample evidence

Risk of resistance Potential nephrotoxicity Limited effectiveness against influenza and coronaviruses

Resistance, nephrotoxicity, side effects, limited effectiveness against influenza and coronaviruses

[33,34,35,36]

Ganciclovir

Converts to the active form ganciclovir triphosphate, competitively inhibits viral DNA polymerase, terminates viral DNA chain synthesis

Human Cytomegalovirus (CMV) infections, especially in immunocompromised patients

Intravenous: 5 mg/kg, once daily for 7–14 days

Significant efficacy against CMV infections Widely used in the treatment of immunocompromised patients

Can cause bone marrow suppression Nausea, liver function abnormalities Long-term use may lead to resistance

Bone marrow suppression, nausea, liver function abnormalities, may lead to resistance, limited effectiveness against HSV

[38,39,40]

Neuraminidase inhibitors (NAI)

Oseltamivir

Inhibits neuraminidase activity, prevents the release of viral particles from host cells

Influenza A and B

Treatment: 75 mg, twice daily for 5 days; Prophylaxis: 75 mg, once daily for 10 days

Convenient oral administration, suitable for self-management by patients with mild symptoms Widely used in clinical practice with ample evidence Low toxicity

Risk of resistance, particularly in H1N1 influenza A Must be used early (within 48 h of symptom onset)

Resistance, common side effects include nausea, vomiting, diarrhea, headache, optimal when administered within 48 h of symptom onset

[51,52,53]

Zanamivir

Inhibits neuraminidase activity, prevents the release of viral particles from host cells

Mild to moderate influenza

Inhalation: 10 mg, twice daily for 5 days; Prophylaxis: 10 mg, once daily for 10 days

Effective against both influenza A and B Administered via inhalation, reducing systemic side effects Low risk of resistance

Inhalation administration limits its use in certain patients (e.g., those with breathing difficulties) Must be used early (within 48 h of symptom onset) May cause bronchospasm

Not suitable for patients with asthma or COPD, may cause throat irritation, coughing, bronchospasm

[55,56,57,58]

Peramivir

Inhibits neuraminidase activity, prevents the release of viral particles from host cells

Severe influenza

Intravenous: 600 mg/kg, single dose

Intravenous administration, suitable for severe cases or patients unable to take oral medications Rapid onset of action, short course of treatment Low risk of resistance

Intravenous administration limits its use in outpatient settings Long-term safety and resistance issues not fully evaluated

Primarily used for hospitalized patients with severe influenza, less frequently used in mild cases

[60,61,62]

M2 ion channel blockers

Amantadine

Blocks the M2 ion channel, inhibits the entry of hydrogen ions into the viral particle, affects viral uncoating

Influenza A

–

Convenient oral administration Relatively inexpensive

High resistance rates, especially in H3N2 and H1N1 subtypes Potential central nervous system side effects (e.g., dizziness, insomnia) Not effective against influenza B

No longer recommended for clinical use due to high levels of resistance

[63,64,65]

Rimantadine

Blocks the M2 ion channel, inhibits the entry of hydrogen ions into the viral particle, affects viral uncoating

Influenza A

–

Convenient oral administration Fewer central nervous system side effects compared to amantadine

Still has a high risk of resistance Not effective against influenza B Long-term safety needs further research

No longer recommended for clinical use due to high levels of resistance

Interferons (IFN)

Interferon α/β/γ

Binds to specific receptors on cell surfaces, activates signaling pathways, induces the production of antiviral enzymes, enhances immune response

Various viral pneumonias, such as SARS-CoV-2 and influenza

Varies by type and condition, typically administered via nebulization or injection

Broad-spectrum antiviral activity Enhances host immune response Effective against multiple viruses

May cause severe systemic side effects (e.g., fever, fatigue, myalgia) Requires frequent injections Long-term safety concerns

Minimal severe side effects, but may cause flu-like symptoms such as fever and muscle pain

[65, 68]