Intranasal Antiviral Agents and COVID-19 1 Intranasal Antiviral Drug Delivery and Coronavirus Disease (COVID-19): A State-of-the-Art

WHITE JOURNAL FORMAT) 48 Objective: To provide a state-of-the-art review of intranasal antiviral drug delivery and to discuss 49 current applications, adverse reactions, and future considerations in the management of 50 Coronavirus Disease (COVID-19). 51 Data sources: PubMed, Embase, and www.clinicaltrials.gov search engines. 52 Review Methods: A structured search of the current literature was performed of dates up to and 53 including April 2020. Search terms related to topics of antiviral agents and intranasal 54 applications were queried. A series of video conferences was convened of experts in 55 otolaryngology, infectious diseases, public health, pharmacology, and virology to review the 56 literature and discuss relevant findings. 57 Conclusions: Intranasal drug delivery for antiviral agents have been studied for many years. 58 Several agents have broad-spectrum antiviral activity, but they still require human safety and 59 efficacy trials prior to implementation. Intranasal drug delivery has potential relevance for future 60 clinical trials in the settings of disease spread prevention and treatment of SARS-CoV-2 and 61 other viral diseases. 62 Implications for Practice: Intranasal drug delivery represents an important area of research for 63 COVID-19 and other viral diseases. The consideration of any potential adverse reactions is 64