Anaferon: instructions for use, children, drops, adults, tablets,

Operating principle

The composition of the drug at first glance may raise questions. The instructions say: contains affinity purified antibodies to human interferon gamma. Everyone knows that interferons are the main part of our immunity, so why act against them with “anti” bodies? The idea is that ultra-low doses of antibodies lead to an enhanced immune response. Anaferon triggers a whole cascade of protective reactions, increasing the production of alpha, beta and gamma interferon, killer cells, phagocytes and many others. As a result, a person fights influenza viruses, ARVI, as well as herpes types 1 and 2 faster and without complications.

The main feature of antibody-based drugs is their safety, and therefore Anaferon is widely used as a prophylactic for influenza and ARVI.

General indications for the use of Anaferon are as follows, complex therapy:

Flu;
Acute respiratory viral infection;
Genital herpes;
Labial herpes.

Given the mildness of the drug, doctors recommend it to people with chronic diseases. Patients who correctly followed the Anaferon dosage regimen highly appreciated its effectiveness.

The manufacturer, Materia Medica, is the leader among our companies that have funded clinical trials (2018). In addition, Anaferon is one of the most studied drugs in its sector. All these facts convince doctors to prescribe it to children starting from the age of one month.

Indications for use Anaferon for children drops

Treatment of ARVI in children from one month to three years.

How to use Anaferon for children in the form of drops?

The treatment regimen with this drug in any form differs in the frequency in the initial period and when taken separately from food. It is more convenient to record time using a clock. For children older than one month, the following dosage is indicated:

The first day of treatment - for 2 hours - 10 drops every 30 minutes, then another 3 times 10 drops at equal intervals; from 2 to 5 days of treatment - 3 times a day, 10 drops

Important! On the initial day, during five doses, drops are given between feedings or 15 minutes before food or water. This rule is also observed when treating with tablets, since food sharply reduces the bioavailability of the drug.

Anaferon for children 25 ml drops for oral administration

Instructions for medical use of the drug Anaferon for children Trade name Anaferon for children International nonproprietary name No Dosage form Drops for oral administration Composition per 1 ml drops for oral administration active substances: Antibodies to human interferon gamma affinity purified 0.006 g*. excipients: maltitol – 0.06 g, glycerol – 0.03 g, potassium sorbate – 0.00165 g, anhydrous citric acid – 0.0002 g, purified water – up to 1 ml. * are administered as a mixture of three active aqueous dilutions of the substance, diluted 10012, 10030, 10050 times, respectively. Description Colorless or almost colorless transparent liquid. Pharmacotherapeutic group Anti-infective drugs for systemic use. Antiviral drugs for systemic use. Direct acting antiviral drugs. Other antiviral drugs. ATX code J05AX Pharmacological properties Pharmacokinetics The sensitivity of modern physicochemical methods of analysis (gas-liquid chromatography, high-performance liquid chromatography, gas chromatography-mass spectrometry) does not allow assessing the content of active substances of the drug Anaferon for children in biological fluids, organs and tissues, which makes it technically impossible to study pharmacokinetics . Pharmacodynamics Pharmacological action – immunomodulatory, antiviral. Preclinical and clinical studies have proven the effectiveness of the drug against influenza viruses, parainfluenza, herpes simplex viruses types 1 and 2 (labial herpes, genital herpes), other herpes viruses (varicella, infectious mononucleosis), enteroviruses, tick-borne encephalitis virus, rotavirus , coronavirus, calicivirus, adenovirus, respiratory syncytial virus (RS virus). The drug reduces the concentration of the virus in the affected tissues, affects the system of endogenous interferons and associated cytokines, induces the formation of endogenous “early” interferons (IFN a/β) and interferon gamma (IFN γ). Stimulates the humoral and cellular immune response. Increases the production of antibodies (including secretory IgA), activates the functions of T-effectors, T-helpers (Tx), normalizes their ratio. Increases the functional reserve of Tx and other cells involved in the immune response. It is an inducer of a mixed Txl and Th2 immune response: it increases the production of Txl (IFN γ, IL-2) and Th2 (IL-4, 10) cytokines, restores (modulates) the Th1/Th2 balance. Increases the functional activity of phagocytes and natural killer cells (EK cells). Has antimutagenic properties. Indications for use As part of complex therapy of acute respiratory infections of the upper respiratory tract in children aged 1 month to 3 years inclusive. Directions for use and dosage: 10 drops per dose (drops are dosed into a spoon). On the first day of treatment: the first 2 hours, 10 drops every 30 minutes, then, for the remaining time, 3 more times at equal intervals. From 2 to 5 days: 10 drops 3 times a day. The drug is taken without meals. On the first day of treatment, the first five doses of the drug should be taken between feedings or 15 minutes before feeding the child or taking fluids. Side effects Possible reactions of increased individual sensitivity to the components of the drug. Contraindications - increased individual sensitivity to the components of the drug; - children up to 1 month; - persons with hereditary fructose intolerance Drug interactions No cases of incompatibility with other drugs have been registered to date. Special instructions The safety of using Anaferon for children in pregnant women and during lactation has not been studied. Effect of a medicinal product for medical use on the ability to drive vehicles and machinery Anaferon for children does not affect the ability to drive vehicles and other potentially dangerous mechanisms. Overdose No cases of overdose have been identified to date. Release form 25 ml in colored glass bottles (type III for hydrolytic stability), sealed with tamper evident caps, with a dropper. Each bottle, along with instructions for medical use in the state and Russian languages, is placed in a cardboard pack. Storage conditions: At a temperature not exceeding 25 °C. After opening, store the bottle at a temperature not exceeding 25 °C for 35 days. Do not freeze! Keep out of the reach of children. Shelf life 3 years Do not use after the expiration date Conditions for dispensing from pharmacies Without a prescription Manufacturer/Packager NPF MATERIA MEDICA HOLDING LLC; Russia, 127473, Moscow, 3rd Samotechny lane, 9. Tel./fax. Address of the place of production of the drug Russia, 454139, Chelyabinsk, st. Buguruslanskaya, 54. Registration certificate holder of NPF MATERIA MEDICA HOLDING LLC, Russia. Name, address and contact details (telephone, fax, e-mail) of the organization that accepts claims on the quality of medicines from consumers on the territory of the Republic of Kazakhstan and is responsible for post-registration monitoring of the safety of the medicine. Representative office of NPF MATERIA MEDICA HOLDING LLC in the Republic of Kazakhstan. Almaty, st. Seifullina 498. Tel./fax: 2734713 E-mail

Indications of the drug and dosage for Anaferon tablets for children

Influenza and ARVI, prevention and treatment, age 1 month - 18 years
Complex therapy of infectious mononucleosis and chickenpox, from 1 year to 18 years
complex therapy of rotavirus infections, 6 months - 18 years

Dosage for tablets

Interestingly, tablets, as well as drops, can be used from 1 month to 3 years, dissolving them in chilled boiled water (1 tablespoon). From the age of three you can use the tablets if you keep them in your mouth until completely dissolved. The regimen is almost the same, the difference is the duration of treatment.

For acute respiratory viral infections and influenza in children over 1 month of age:

1 day of treatment - give 8 tablets, the first 2 hours every 30 minutes (total 5 tablets in two hours). In the future - 3 tablets at equal intervals.
2nd day of treatment and then 1 tablet 3 times a day until recovery.

If you do not feel better after three days, you should seek help from a doctor.

Intestinal rotavirus infection , as part of complex therapy for children over 6 months:

The scheme is the same as for ARVI.

Infections caused by the herpes virus (chickenpox, mononucleosis), complex therapy.

The tactics are similar to those for ARVI, but only for chickenpox - continue treatment for 7 days, and for infectious mononucleosis - 14 days.

Experience of using Anaferon in pediatric practice

The article reviews clinical studies on the use of the drug Anaferon. Anaferon is an antiviral agent with immunomodulatory activity, many years of experience in the use of which has proven the effectiveness and safety of the drug in the treatment and prevention of a wide range of viral and bacterial infectious diseases in children. The key mechanisms of action of Anaferon are the induction of endogenous type I and II interferons, as well as allosteric modulation of the interferon gamma receptor. The authors note that the high safety of the drug, the possibility of its use in children from 1 month of age, and the lack of addiction allow us to recommend Anaferon as the drug of choice for the treatment and prevention of infectious diseases of various etiologies.

Introduction

Infectious diseases remain the most common in childhood, among which acute respiratory diseases and acute intestinal infections occupy one of the leading places. Every year, more than a billion cases of acute respiratory diseases and the same number of acute intestinal infections are registered worldwide.

Children attending school and preschool institutions most often get sick, which is directly related to the increase in the number of contacts. First of all, we are talking about acute respiratory diseases and influenza, which a child suffers on average 8 times in the first year of visiting, 4–6 times in the second year, and 3–4 times in the third year. In total, in 2012, 28 million 423 thousand 135 people in the country suffered from acute upper respiratory tract infections, of which 67% were children under 14 years of age. The incidence rate was 19,896.3 per 100 thousand people, and in children under 14 years old - 87,391.6 per 100 thousand people. The incidence of acute intestinal infections remains high. If in 2002 635,514 cases of acute intestinal infections were registered in the country, then in 2012 there were 808,585 cases of acute intestinal infections. Among the sick, more than 60% are children, most of them under the age of 3 years.

An undoubted achievement in the field of studying acute respiratory diseases and acute intestinal infections should be considered their etiological decoding. A screening survey showed that about 60% of all diarrheal diseases are caused by viruses, most often by rotaviruses (80%), less often by astro-, calici- and adenoviruses (15%) and in 5% of cases the disease is caused by associations of viruses. About 12% of acute intestinal infections are caused by bacteria, the etiology of 28% remains unspecified.

Acute respiratory viral infections (ARVI) also predominate in the structure of acute respiratory diseases (90–95%). The share of bacterial and other acute respiratory diseases (caused by staphylococci, less commonly streptococci, Moraxella catarrhalis, Haemophilus influenzae, Mycoplasma spp

., mushrooms, etc.) account for 5–10%.

Diagnosis of ARVI

Among the reasons for the total prevalence of ARVI, one can highlight the presence of an extraordinary variety of respiratory pathogens, the formation of type-specific post-infectious immunity and the ease of transmission of pathogens. Nevertheless, the predominant tropism for one or another part of the respiratory tract, formed in the process of evolution, makes it possible to identify characteristic signs, which simplifies the differential diagnosis of the disease and allows timely prescription of etiotropic drugs.

Thus, parainfluenza is characterized by symptoms of damage to the laryngeal mucosa, which in 50% of cases manifests itself as croup syndrome. Adenovirus infection is characterized by damage to the mucous membrane of the nasopharynx with the involvement of lymphoid formations in the process with the formation of pharyngotonsillitis and pharyngitis. With respiratory syncytial infection, the pathological process begins with damage to the mucous membrane of small and medium bronchi, which is clinically manifested by expiratory shortness of breath. The initial symptom of influenza infection is tracheitis, and rhinovirus infection is rhinitis.

Thus, topical diagnosis occupies a central place in the system of clinical guidelines in ARVI. In principle, identifying a symptom pathognomonic for a given infection is a central link in the diagnosis of the disease [1]. For example, a feature of the clinical picture of all calicivirus infections is the presence of a symptom complex of damage to the upper gastrointestinal tract (GIT) in the form of nausea, vomiting and abdominal pain, while shigellosis is characterized by colitis syndrome, which is associated with the tropism of Shigella spp

. to the mucous membrane of the large intestine.

Immunotropic drugs in the treatment of ARVI

The idea of the tropism of the lesion (that is, the initiation of the infectious process only if the pathogen is found, recognized and binds to a specific related receptor in the tropic organ) made it possible to determine the main principle of treating an infectious patient - etiotropic. Currently, treatment regimens have been developed based on the use of etiotropic, pathogenetic and symptomatic agents. Numerous studies have shown that in patients with ARVI, timely administration of Anaferon, Algirem or Arbidol leads to a reduction in clinical manifestations by 1.5–2 times compared to standard therapy.

A promising direction in modern therapy for such infections in children is the use of immunotropic drugs, in particular endogenous interferon inducers (IFN). Interferon inducers have a universally wide range of antiviral activity (etiotropic effect) and a pronounced immunomodulatory effect. Against the background of their use, the synthesis of endogenous interferon is balanced and controlled by the body, which prevents a number of side effects characteristic of exogenously administered interferons. A single administration of classical inducers leads to long-term, and in some cases unreasonably long, circulation of endogenous interferon (up to 120 hours or more) [2].

One of the inducers of endogenous interferons alpha and gamma, widely used in the complex therapy of viral and bacterial infections in children, is the domestic drug Anaferon for children. In the production process of this drug, technological processing of the starting substance is used, which leads to the release of a special physicochemical, biological and pharmacological activity called release activity. Thus, Anaferon for children contains affinity-purified antibodies to IFN-gamma in a release-active form [3].

Release-active antibodies to IFN-gamma have a specific modifying effect on the antigen to which they are produced [3], causing conformational (spatial) changes in the IFN-gamma molecule. In addition, it was found that release-active antibodies to IFN-gamma enhance the interaction of IFN-gamma with its receptor (increase the amount of IFN-gamma bound to the receptor) and change the affinity of the interaction of IFN-gamma with antibodies to IFN-gamma [4, 5].

In a series of preclinical studies, it was shown that when administered prophylactically and/or therapeutically, release-active antibodies to IFN-gamma have an antiviral effect against RNA and DNA viruses and immunotropic activity. The antiviral and immunotropic effect is realized due to the influence on the functional activity of natural factors of immune defense (cellular, humoral immune response, phagocytic activity of neutrophils and macrophages). The wide range of immunotropic effects of the drug is associated with the involvement of the interferon system in the implementation of pharmacological activity, in particular IFN-gamma, the induction of which is a key mechanism of its action [4–8].

Like other interferon inducers, Anaferon for children promotes the production of endogenous interferons. However, unlike classical inducers, Anaferon for children has a selective effect on the production of endogenous IFN alpha and gamma, depending on the presence of the virus in the body. The selectivity of Anaferon's action is manifested in the fact that during the acute period of a viral infection it activates all types of interferon production (spontaneous and stimulated/induced production). This results in an increase in serum concentrations of IFN alpha and gamma to levels sufficient to combat infection. As the virus is eliminated and during the convalescence period, the stimulating effect of Anaferon for children on interferonogenesis decreases. This leads to the fact that by the time the drug is finished (the treatment regimen involves taking the drug for 5–7 days), there is a decrease in the content of interferons in the serum until a normal level is reached without developing a state of hyporeactivity. During this period, the effect of Anaferon for children is manifested by higher (compared to placebo) levels of induced production of IFN alpha and gamma, reflecting the functionality of the IFN system in the event of recurrent infection. Anaferon for children has a similar effect when used prophylactically [3].

Thus, depending on whether there is contact with viruses, Anaferon for children acts differently. During infection, the drug actively stimulates the production of interferons, increases the expression and binding ability of IFN-gamma receptors. Outside of contact with viruses, the drug increases the functional reserves of the interferon system and maintains the child’s body in a state of high readiness to protect against viruses. It should be noted that the ability to influence the reception of IFN-gamma also distinguishes Anaferon for children from other inducers. Optimization of ligand-receptor interactions of IFN-gamma molecules with its receptor may underlie the physiological nature of the action of Anaferon for children. Under conditions of more complete interaction of IFN molecules with receptors, the regulatory effects of IFN-gamma are realized more quickly. On the one hand, this leads to a faster activation of the immune response, and on the other hand, stimulation of the IFN system stops faster through feedback channels [9, 10].

The described properties of Anaferon for children allow its use in repeated therapeutic and prophylactic courses without excessive stimulation of IFN, and therefore, without the risk of depletion of the immune system and the development of a stage of hyporeactivity, which is possible when using other IFN inducers. This also determines the possibility of using Anaferon for children in patients at risk, whose immune system requires a more balanced effect [9]. All of the above indicates the wide therapeutic potential of Anaferon for children, and taking into account the fact that the drug is approved for use in children aged 1 month and older, it can be considered the drug of choice in pediatric practice.

Anaferon for children in the treatment and prevention of influenza and ARVI in children

Currently, a fairly impressive number of studies have been conducted confirming the effectiveness and safety of Anaferon for children in the treatment and prevention of influenza and ARVI in children [11, 12]. Experts note that most studies were comparative, randomized and prospective. A significant part of the work involved the use of placebo control and various masking methods (simple and double blinding) [11].

As part of an expert assessment of 10 years of clinical experience in the use of Anaferon for children, presented at the XX National Congress “Man and Medicine”, Professor E.G. Kondurina noted that over the past decade, clinical studies of Anaferon took place in more than 40 cities of Russia, more than 50 research centers participated in their implementation, and the number of patient participants approached 6,000.

Anaferon for children is most widely used for the treatment and prevention of acute respiratory viral infections. This also determines the predominance of studies devoted to this topic. In the available literature sources you can find information about 27 comparative studies on the use of Anaferon for this pathology in children aged 1 month to 15 years. The vast majority of studies were randomized, and five studies were double-blind placebo-controlled [11, 12].

Thus, according to a two-center randomized placebo-controlled study, the prophylactic use of Anaferon for children in a group of more than 200 people reduced the average number of ARVI episodes by 2.3 times compared with the placebo group (p

The therapeutic effect of Anaferon for children during a multicenter, randomized, double-blind, placebo-controlled clinical trial was manifested in a reduction in the duration of the main symptoms of influenza by 24–43 hours. Thus, the duration of hyperthermia was 54 ± 3.1 hours versus 88.1 ± 2.9 hours in the placebo group (p

It should be noted that Anaferon for children is widely used for the prevention and treatment of viral infections in children at risk for the development of ARVI and complications. These groups include children with secondary immunodeficiency conditions, as well as children with concomitant pathologies that limit the possibility of using pharmacotherapeutic methods for the prevention of ARVI [11]. Research by Professor N.K. Perevoshchikova (Kemerovo) showed the feasibility of including Anaferon for children in the program for the management of frequently ill children with pathology of the lymphopharyngeal ring. It has been proven that the use of preventive courses of Anaferon for children reduces the incidence of ARVI in this category of children by 2.5 times. Moreover, the preventive effect after completion of the 3-month rehabilitation and preventive program remains for another 1.5–2 months (total observation period - 5 months). In addition to clinical effects in frequently ill children receiving Anaferon for children, elimination of microorganisms from the mucous membrane of the nasopharynx is noted. At the same time, the detection of Staphylococcus aureus decreased by 1.5 times, and positive smears for hemolytic streptococcus were detected 6 times less often than in the control group. In nasocytograms of children who received a course of Anaferon for children, there was a significant increase in the number of columnar epithelium, a decrease in sensitization of the nasopharyngeal mucosa, a decrease in the adsorption index of squamous epithelium, which indirectly confirmed a decrease in the content of microorganisms on the mucous membranes of the upper respiratory tract. When using Anaferon for children, a significant increase in lysozyme activity and an increase in the level of IgA and sIgA in nasal secretions were recorded [18–20].

Anaferon for children in the treatment and prevention of acute respiratory viral infections in children suffering from atopic diseases

Pediatricians and allergists have accumulated extensive experience in using Anaferon for children as an antiviral drug and an inducer of interferons, primarily IFN-gamma, in children suffering from atopic diseases. Randomized comparative and placebo-controlled studies were conducted at the Center for Child and Adolescent Health (Moscow), Siberian State Medical University (Tomsk), Novosibirsk State Medical University (Novosibirsk), ChelSMA (Chelyabinsk), as well as in Dnepropetrovsk [21–26]. Prophylactic use of Anaferon for children made it possible to reduce the number of children who suffered acute respiratory infections during the epidemic period by 2–2.5 times, and to reduce the incidence of ARVI by 3.5 times. In addition, under the influence of the drug, the frequency of virus-induced exacerbations of allergic diseases was reduced. For example, the average number of exacerbations of bronchial asthma in the group of children receiving Anaferon was 0.43 ± 0.08 compared to 0.88 ± 0.02 in the placebo group (p

A study of the therapeutic effectiveness of Anaferon for children in acute respiratory viral infections in children with allergic diseases demonstrated the ability of the drug to reduce the severity and duration of intoxication syndrome and catarrhal phenomena, as well as good tolerability of Anaferon. The Influenza Research Institute of the Ministry of Health of the Russian Federation showed that the inclusion of Anaferon for children in the complex therapy of 100 children aged 6 months and older with a history of dermato- and respiratory allergies and combined damage to the respiratory and gastrointestinal tract led to a significant decrease in the proportion of people with elevated body temperature already after 1 day of taking the drug, compared with the group receiving placebo. In addition, after 3 days, the number of children with persistent symptoms of intoxication and gastrointestinal manifestations significantly decreased, and after 4 days - with catarrhal phenomena in the nasopharynx and auscultatory changes in the lungs. In general, signs of acute infection were eliminated on the 5th day in the main group and on the 8th day in the placebo control group. Clinical improvement was accompanied by an increase in serum INF alpha and gamma levels on days 2–3 of illness, as well as in the levels of sIgA, CD3, and CD16. It should be emphasized that by the time of recovery, serum levels of interferons were normalized. The treatment course of Anaferon led to a statistically significant reduction in the release of viral antigens in the nasal passages of these children.

Anaferon for children in the treatment of acute intestinal viral infections

The wide distribution of rotavirus infection in pediatrics is explained by high natural susceptibility, especially in young children. The leading role in antiviral protection, starting from the earliest stage of penetration of rotavirus into the gastrointestinal mucosa, belongs to the interferon system. By inhibiting the processes of transcription and translation of viral templates, they are able to suppress the replication of many RNA and DNA viruses [27, 28]. The effectiveness of including Anaferon for children in the treatment of acute intestinal infections of viral (rotavirus and calicivirus infections), viral-bacterial nature, as well as the prevention and treatment of acute infections with combined damage to the respiratory and intestinal tracts has been studied and confirmed by a number of authoritative experts [12, 27–32 ]. It was shown that the inclusion of Anaferon for children in the treatment regimen for patients with ARVI with gastrointestinal lesions (adeno-, corona-, calici- and rotavirus infections) led to a reduction in fever (1.3 times), intoxication (1.9 times), catarrhal symptoms (2.5 times) and manifestations of gastrointestinal dysfunction (1.4 times), and also shortened the period of isolation of viral antigens from convalescents and led to the discharge of children at an earlier time [27, 32].

Placebo-controlled studies conducted at the Research Institute of Children's Infections of the FMBA, at the Central Research Institute of Epidemiology of Rospotrebnadzor, at the Department of Children's Infectious Diseases of Rostov State Medical University, indicate the advisability of including Anaferon for children in the complex therapy of rotavirus gastroenteritis [32]. A significant reduction in the duration of the main manifestations of the disease was demonstrated in 29 children aged 1 to 8 years. Thus, the symptoms of intoxication were relieved for 24–36 hours, fever – for 48–50 hours, and the restoration of stool character – 2.3 days earlier compared to children receiving standard therapy.

Similar data indicating the cessation of rotavirus isolation in 90% of cases on the 5th day of treatment with Anaferon were obtained by N.Kh. Tkhakushinova and N.G. Soboleva [31]. This fact is apparently due to the activating effect of the drug on antiviral resistance and the immune response, which ensures accelerated sanitation of the body from rotavirus, despite the known tendency of the latter to long-term persistence [27, 28].

The data obtained in a study conducted under the guidance of Professor A.V. deserve special attention. Gorelova [32]. The use of Anaferon for children for the treatment of rotavirus infection made it possible to prevent infection of children during their hospital stay. Thus, among children who received placebo as part of complex therapy for rotavirus infection, by the time of discharge, the number of children in whom the presence of viral-bacterial mixtures in the feces was determined by PCR method increased by 10%, while in the group of children who received Anaferon for children, No such phenomena were noted.

Thus, the interferonogenic activity of Anaferon for children in respiratory and intestinal infections of viral etiology and their combination has a positive effect on various parts of the humoral and cellular antiviral immune response. As a result of the antiviral and immunomodulatory activity of Anaferon for children in the treatment of rotavirus infection, the concentration of the virus in the affected tissues of the gastrointestinal tract decreases and the rate of its elimination increases. This is important both for a specific child and for the pediatric population as a whole, since it prevents prolonged viral shedding by convalescents and helps reduce the level of sporadic and outbreak morbidity.

The prospects for the use of Anaferon in pediatric practice are not limited only to viral infections. In a study conducted by I.V. Babachenko et al. showed that the inclusion of Anaferon for children in the treatment of pertussis infection in children contributed to a reduction in the incidence of intercurrent ARVI by 2–2.5 times compared to the control group, and a reduction in the incidence of pneumonia and bronchitis from 50 to 20% [33].

Use of Anaferon for children in other infections and immunodeficiency conditions

The presence of Anaferon for children not only has an antiviral effect, but also immunomodulatory activity, which makes it possible to effectively use it against the background of secondary immunodeficiency states, chronic infections, which are most difficult to treat due to the high variability of causative viruses and their ability to suppress the immune response. Based on the results of a double-blind, placebo-controlled, randomized clinical trial, conclusions were drawn about the effectiveness and safety of Anaferon for children in the treatment of chickenpox in children [34]. Revealed significant (p

The experience of using Anaferon in children from 4 months to 3 years with HIV infection who had perinatal contact with HIV infection (stages A1–B3) is interesting. According to V.N. Timchenko, against the background of the preventive course of the drug, there was a decrease in the incidence of ARVI, and a quarter of the children in the group did not get sick at all during the observation period, while in the control group the incidence of ARVI was one hundred percent. The proportion of children with repeated ARVI decreased by 2 times. When assessing the therapeutic effectiveness of Anaferon for children in children with HIV infection and contacts of HIV infection (the drug was used according to a standard treatment regimen), it was found that the duration of the main symptoms of ARVI is reduced by 1.5–2.3 times. The safety of using Anaferon for children in HIV-infected young children has also been shown [35].

Currently, there is data on the use of Anaferon for children in infectious mononucleosis, hemorrhagic fever with renal syndrome, pseudotuberculosis and yersiniosis, whooping cough, tubulointerstitial nephritis, enteroviral and meningococcal meningitis, as well as ARVI in children with concomitant cardiac pathology [36–39].

Conclusion

The collected evidence base, which includes registered and published clinical studies with a high level of evidence, allows us to recommend the widespread use of Anaferon for children in practical medicine, including in pediatrics. Anaferon for children occupies a special place in the treatment of influenza and ARVI, which is associated with the physiological effect of the drug on induced interferonogenesis, on the IFN-gamma system. Anaferon for children is not addictive, which allows it to be used to treat children prone to frequent respiratory infections.

A wide range of antiviral activity allows us to classify Anaferon for children as the drug of choice in the treatment of children with viral infections manifested not only by respiratory, but also by other, including gastrointestinal, symptoms. Finally, the combination of effectiveness with a high safety profile plays a special role in the treatment of viral infectious and inflammatory diseases in children with allergic and other underlying pathologies.

Indications for use of Anaferon for adults in tablets

ARVI, influenza, prevention and treatment as part of complex therapy;
Labial (herpes on the lips) and genital herpes, in complex therapy.

Anaferon dosage for adults

For labial herpes or “colds on the lips” , ARVI, influenza. The dosage regimen is the same as for children's tablets for ARVI. They need to be absorbed between meals.

For preventive purposes during the ARVI season, take 1 tablet per day for 1-3 months.

For genital herpes in acute form . There is a difference in the treatment of this pathology - 1-3 days, 1 tablet 8 times a day at equal intervals, and then - 1 tablet 4 times a day for 3 weeks.

Treatment of relapses of the chronic form of the herpes virus, 1 tablet per day, the duration is determined by the doctor, can reach 6 months.

It should be noted that the drug combines well with other antiviral agents.

Evaluation of the effectiveness of anaferon for children in the nonspecific prevention of ARVI in primary schoolchildren

According to the Federal Service for Surveillance on Consumer Rights Protection and Human Welfare for 2005, about 16.5 million cases of acute respiratory viral diseases (ARVI) were registered among children under the age of 14 years, of which the share of cases of confirmed influenza amounted to 2.3% - more than 370 thousand [1].

Respiratory pathology is caused by about 300 types of pathogens. This is a large group of microorganisms, which includes not only viruses (influenza A and B viruses, adenovirus, parainfluenza virus, RS virus, rhino- and reoviruses, coronavirus and picornaviruses, etc.) - about 200 species, but also other pathogens : opportunistic infections, bacteria and fungi [2, 3].

Currently, there are three main ways to control ARVI and influenza: vaccination, chemotherapy and nonspecific prophylaxis [4]. Vaccination against influenza viruses, while providing a stable and long-lasting protective effect, unfortunately has a narrow focus. In addition, the constantly changing antigenic properties of the influenza virus, associated with its high variability, significantly complicate the implementation of complete vaccine prevention [5].

Chemotherapy involves the use of synthetic and natural substances that affect the reproduction of viruses. However, the rather narrow spectrum of action and the possibility of rapid development of viral resistance to drugs of this class limits their use [5].

In this regard, it is now quite natural to focus attention on nonspecific prevention of acute respiratory viral infections and influenza, associated primarily with an increase in the activity of natural anti-infective defense mechanisms.

Particular importance in programs for seasonal nonspecific prevention of influenza and ARVI is given to immunomodulatory agents and inducers of endogenous interferons [5]. Currently, an interesting drug is one of the representatives of this group - anaferon for children.

It contains affinity-purified antibodies to human γ-interferon (γ-INF): a mixture of homeopathic dilutions C12, C30 and C50. According to numerous literature data, anaferon for children has immunomodulatory and antiviral effects [6, 7, 8].

It is known that the production of interferons is an important component of a complete immune response to a viral infection and largely determines the nature of the course of the disease [9]. Anaferon has a versatile modulating effect on all parts of the immune system and interferon status [6, 8, 10]. Thus, anaferon induces and modulates the formation of endogenous “early” interferons α, β and, most importantly, γ-INF. Interferons suppress virus replication and prevent infection of other cells. Under the influence of anaferon, the functional activity of macrophages and NK cells (cytotoxic lymphocytes), which lyse already infected cells, also increases. All these processes underlie the relatively rapid antiviral effect of anaferon [6, 8, 10].

In addition, anaferon affects the production of endogenous cytokines, restores their activity and modulates functionally associated processes. Anaferon is an inducer of both cellular (through Th-1) and humoral (through Th-2) immune response: it increases the production of Th-1 cytokines (γ-IFN and interleukin (IL)-2) and Th-2 (IL-2). 4, IL-10). In addition, anaferon regulates the ratio of Th-1 and Th-2 activities and increases the production of antibodies (including secretory immunoglobulin A) [6].

Due to the use of special production technology, the active substance in the drug is contained in ultra-low doses. In this regard, anaferon is highly safe and can be widely used as a means of nonspecific prevention of influenza and ARVI during an epidemically dangerous period in organized children's groups [11]. Anaferon for children is indicated for healthy children for the prevention of acute respiratory viral infections and influenza, as well as for children belonging to the group of people who are often and long-term ill [12, 13, 14].

In January–February 2005, to study the effectiveness of children's Anaferon in the prevention of acute respiratory viral infections and influenza, we conducted a comprehensive study at a secondary school of a healthy child.

For prophylactic use, Anaferon for children was used during an epidemic period, 1 tablet per day for 40 days, sublingually. This scheme has proven itself on the positive side; it is simple and convenient to use in mass children’s groups [11, 12, 13, 14].

The study involved 200 children in 1st and 2nd grades aged 7 to 8 years. When forming the main and control groups, randomization (a simple method) was used, which ensured the homogeneity of the groups. The children who made up the main group (100 children) received anaferon for children for nonspecific prevention of ARVI. The control group (100 children) included children who did not receive nonspecific prevention of ARVI and influenza. As a result of randomization, children from both the main and control groups were present in each class. Analyzing the effectiveness of preventing influenza and ARVI with the drug Anaferon for children, it should be noted that during the epidemic, only 13% of children receiving this drug fell ill, while in the group of schoolchildren who did not receive non-specific means of preventing ARVI, 58% fell ill (Fig. 1).

Figure 1. Incidence rate of ARVI in children in organized children's groups

The security indicator was about 77.6%. Significance was assessed using two-sided Fisher's test (p < 0.001).

According to the objectives, the features of the course of ARVI, in particular, the severity of the disease, were separately analyzed.

Only 6 children from the main group had a severe course of ARVI, while in the control group 28 children suffered a severe acute respiratory disease. These differences are also significant according to the two-sided Fisher test (p < 0.001) (Fig. 2).

Figure 2. Proportion of children who suffered severe ARVI

When assessing pharmacoeconomic effectiveness, we used data from I. L. Shakhanina [15]. The cost of nonspecific prevention of ARVI with anaferon for children was 24,500 rubles. The cost of treating cases of ARVI is 74,200 rubles. Thus, the total costs in the main group amounted to 98,700 rubles. An assessment of the preventive effect showed that the use of Anaferon for children prevented 45 cases of ARVI, including 23 episodes of complications from ARVI. At the same time, the prevented economic damage amounted to 270,900 rubles. When comparing the costs of nonspecific prevention of ARVI with anaferon for children with the amount of prevented economic damage, it turned out that the economic benefit from the use of anaferon for children in junior high school per 100 children amounted to 172,200 rubles.

Based on the results of our study, the following conclusions can be drawn:

anaferon for children has shown high effectiveness as a means for nonspecific prevention of acute respiratory viral infections in children in secondary schools in relation to influenza and acute respiratory viral infections during an epidemically dangerous period, during the winter season of 2004-2005;
the absence of contraindications, as well as the absence of side effects, a convenient method (sublingual tablet) and a regimen of use (1 tablet once a day, daily for 40 days) allow the widespread use of Anaferon for children in mass children's groups;
anaferon for children can be successfully used for mass prevention of influenza and ARVI, as well as their complications in school groups during seasonal diseases of the respiratory tract;
The economic efficiency of using anaferon for children among primary school students, as studies have shown, is quite high.

Literature

Infectious disease incidence in the Russian Federation for January-December 2005. Reference information of the Federal Service for Surveillance in the Sphere of Protection of Consumer Rights and Human Welfare of the Federal State Health Institution, “Federal Center for Hygiene and Epidemiology.”
Evstropov A. N. Pathogens of acute respiratory viral infections in humans // Clinical antimicrobial chemotherapy. 2001. T. 3. No. 1-2. pp. 38-41.
Kolobukhina L.V. Viral respiratory tract infections//Russian Medical Journal. 2000. T. 8. No. 13-14. pp. 559-564.
Drinevsky V. P., Osidak L. V., Tsybalova L. M. Acute respiratory infections in children and adolescents: a practical guide / ed. O. I. Kiseleva. St. Petersburg: SpetsLit, 2003. P. 181.
Ershov F.I., Kasyanova N.V., Polonsky V.O. Is rational pharmacotherapy of influenza and other acute respiratory viral infections possible? // Consilium Medicum. 2003. T. 5. No. 6. P. 129-135.
Osidak L.V., Afanasyeva O.I., Drinevsky V.P. Anaferon for children. A new remedy in the treatment and prevention of influenza and acute respiratory infections in children: a method. manual for doctors. St. Petersburg, 2003. P. 25.
Chuvirov G. N., Markova T. P. Antiviral therapy in the treatment of influenza // Russian Medical Journal. 2004. T. 12. No. 21. P. 1216-1226.
Uchaikin V.F., Epshtein O.I., Sergeeva S.A., Orlova T.G., Kharlamova F.S. et al. Anaferon for children. Domestic immunocorrector with antiviral activity: a manual for pediatricians and infectious disease specialists / ed. V. F. Uchaikina. M., 2003. P. 35.
Ershov F.I. The interferon system in normal conditions and in pathology. M.: Medicine, 1996. P. 240.
Martyushev-Poklad A. V. Mechanisms of antiviral and immunomodulatory effects of ultra-low doses of antibodies to interferon gamma: dis. ...cand. honey. Sci. Tomsk, 2003. 119 p.
Timchenko V. N., Chernova T. M. Modern methods of influenza prevention // Terra Medica. 2005. No. 4. P. 14-18.
New opportunities for the prevention and treatment of acute respiratory viral infections in children: effectiveness and safety: Based on materials from the scientific and practical conference “Pharmacotherapy in Pediatrics” 2005 // Polyclinic. 2006. No. 1. P. 10-11.
Lytkina I. N., Volkova N. A. Experience in the use of some modern drugs during nonspecific prevention of ARVI in children's organized groups // Children's infections. 2004. No. 4. P. 49-54.
Kuprina N. P., Kokoreva S. P., Semenchenko L. V., Shishlova S. A., Ragozina V. N. Clinical and laboratory effectiveness of the use of “Anaferon for children” in the complex therapy of frequently ill children. // Childhood diseases. 2005. No. 3. P.54-58.
Shakhanina I. L., Osipova L. A. Economic losses from infectious diseases in Russia: values and trends // Epidemiology and infectious diseases. 2005. No. 4. pp. 19-21.

T. I. Garashchenko, Doctor of Medical Sciences, Professor L. I. Ilyenko, Doctor of Medical Sciences, Professor M. V. Garashchenko Russian State Medical University, Moscow

Analogs

There are almost no drugs on the Russian market that are identical in composition to Anaferon. Antibodies to interferon form the basis of a brand such as Ergoferon, but they also include affinity-purified antibodies to histamine and CD4 - that is, they are not a complete analogue. However, the action of these two drugs is very similar and replacement can be made. The difference, when it comes to age, is that Ergoferon tablets are approved for children from 6 months of age. Otherwise, Ergoferon has a broader and stronger effect; a separate article will be required to describe it.
Other remedies with a similar level of safety include Oscillococcinum granules, although it is not indicated against herpes.
A suitable replacement can be made from a group of interferon-based drugs. They have a wide spectrum of action against various viruses, are very gentle and are suitable for children, the elderly or those with poor health. These include brands such as Grippferon and Viferon, they have the same active ingredient - human recombinant interferon alpha-2b.
Other antiviral drugs do not have the same level of safety, but they can be used for older children and adults. The widest group is, of course, interferon inducers. In particular, Cycloferon has the same indications as Anaferon and is approved for children from 4 years of age. In the same group there is also a fairly strong drug Amiksin (Tiloron), which acts not only on the causative agent of influenza, but also on the hepatitis virus, cytomegalovirus and others. The question arises: is such strong treatment necessary for ordinary ARVI? Only a doctor can give objective advice. Concluding the characterization of interferon inducers, let us also introduce Kagocel, it is not allowed for infants (allowed from three years of age), the indications are similar to Anaferon.
Among other common remedies, Ingavirin should be mentioned; in addition to its antiviral effect, it also has anti-inflammatory properties. There is a syrup form for children from three years of age and capsules for adults.
But the most famous is, perhaps, Arbidol. Several dosages of capsules are available, and for children from two years of age they have a powder for preparing a suspension. Arbidol is also used to treat rotavirus infections as part of complex therapy.

In general, immunomodulators have one common property - they act differently on all patients. Even a doctor can make a mistake with the choice, but Anaferon is distinguished by the absence of side effects and the low price of the course compared to its competitors.