Quo vadis, erdostein? Or the current and future potential of erdosteine in practice

Importance of Thiol Groups

Erdosteine is a homocysteine derivative. It contains closed thiol groups, whose cyclic structure opens up after liver metabolism during the first-pass effect, creating 3 active metabolites with the following valuable properties for the treatment of respiratory diseases:

• They positively affect mucociliary clearance, with a greater effect than N-acetylcysteine, ambroxol, or sebrerol.
• In vitro they exhibit antioxidant effects on neutrophils and eosinophils.
• In vivo they regulate reactive oxygen species produced by neutrophils.
• They inhibit the release of elastase from neutrophils, thus favorably affecting the inflammatory process.
• They have an antibacterial effect influencing bacterial adhesion to human mucosal epithelial cells. Significant reduction was observed in bacteria such as Staphylococcus aureus and Escherichia coli.
• In vivo they inhibit the activation of tumor necrosis factor α and interleukin 1β.

Erdosteine's Effects on Viral Diseases Including COVID-19

Although there is no direct data on erdosteine's ability to prevent viral infections, thio-based drugs have been found to have potential effects against influenza.

In a study monitoring antibiotic treatment of pediatric patients with recurrent respiratory infections between 2013 and 2016, among more than 300 children with a history of recurrent acute upper respiratory infections, early administration of erdosteine at the initial signs of this disease presumed to be of viral origin led to a reduction in the need for antibiotic therapy and a decrease in respiratory infections.

The application of this drug in the therapy of viral diseases can also be supported by data from an observational study from 2020, which evaluated its effects on patients with COVID-19 associated with pneumonia and severe respiratory failure. In patients who were given erdosteine as part of their therapy post-discharge, symptoms such as fatigue and shortness of breath persisted for a shorter duration.

Benefits in Pediatric Population

Several aspects indicate the suitability of administering erdosteine to children, including the following:

• It can be used in the treatment of both acute and chronic forms of respiratory diseases.
• Its tolerability in children is rated as excellent.
• Ampicillin in combination with erdosteine shows significantly better effects in the treatment of acute lower respiratory tract diseases in the pediatric population than ampicillin with a placebo.
• Erdosteine also shows synergistic potential with amoxicillin, clarithromycin, and ciprofloxacin.
• Studies demonstrate an improvement in respiratory symptoms in children after short-term use of this drug.
• Erdosteine can be administered from a body weight of 15 kg.

Summary for Practice

The indications for erdosteine have expanded since its discovery to include the following:

• rhinitis
• sinusitis
• laryngopharyngitis
• hypersecretory asthma bronchiale
• chronic obstructive bronchitis, including its acute infectious exacerbations
• chronic obstructive pulmonary disease (COPD)
• bronchiectasis
• prevention of recurrent infectious episodes and complications post-surgery

In the pediatric population, erdosteine is currently used primarily for the treatment of acute and chronic lower respiratory tract diseases, which are expected to produce viscous mucus and increased expectoration. When deciding on treatment, it should be considered that compared to some other commonly used mucolytics, it shows better effects in many respects. For parents and patients, it may also be attractive that it is essentially a simple molecule derived from organic substances, namely acetic acid and cysteine.

(tich)

Sources:
1. Lapka M. Current therapeutic possibilities of erdosteine. Pediatrics for Practice 2021; 22 (1): 12–15.
2. SPC Erdomed. Available at: www.sukl.cz/modules/medication/download.php?file=SPC164354.pdf&type=spc&as=erdomed-spc