Efficacy of inosine pranobex in the treatment of acute respiratory infections in children and adolescents with recurrent respiratory infections, inflammation of the nasopharyngeal tonsil and persistence of herpes viruses
Objective. To evaluate the effect of inosine pranobex (Normomed®, 500 mg tablets) used as part of complex therapy of acute respiratory viral infections in children with recurrent respiratory infections, adenoiditis and persistence of herpes viruses on the severity of complaints and symptoms, as well as on the persistence of herpes viruses on the nasopharyngeal mucosa. Patients and methods. An observational comparative prospective study with 50 children aged 3 years and older, with confirmed persistence of herpes viruses (by PCR) was performed. All children received elimination and irrigation therapy and topical antimicrobials. Patients of group 1 additionally received inosine pranobex (Normomed®, 500 mg tablets) in 3 courses of 10 days with a break of 8 days. The children were monitored during 3 face-to-face visits, during which routine ENT examination, endoscopic examination, repeated PCR-diagnostics were performed (Visit 1 – baseline/Day 0, Visit 2 – on day 10 ± 1 and Visit 3 – day 47 ± 1 from the beginning of observation). We evaluated the presence and severity of adenoiditis symptoms, the size of the nasopharyngeal tonsil (NT), the presence of herpes-virus DNA according to repeated PCR, as well as the proportion of patients who achieved herpes-virus elimination on the background of marked and maximum clinical improvement (complete therapeutic result). Results. DNA of human herpes virus type 6 (HHV-6) and Epstein-Barr virus – EBV were detected most frequently in the groups (96% and 37% and 87% and 43% in groups 1 and 2, respectively). Simultaneous DNA detection of viruses 2 and 3 was observed in 33% and 11% in group 1, and in 30% and 9% of patients in group 2. Grade 2 NT hypertrophy was observed in 33% and 35% and grade 3 hypertrophy in 67% and 61% of children in groups 1 and 2, respectively. By visit 3, EBV elimination was achieved in 40% and HHV-6 in 23% of patients in group 1 versus 20% and 23% in group 2, respectively (difference statistically significant, p < 0.01. In group 2, there was a ‘relapse’ of EBV (20%) and HHV-6 (15%) detection. The risk of herpes virus DNA detection by the 3rd visit was significantly higher in group 2 compared with group 1 (RR = 1.5 [1.1-2.1]). Reduction in the degree of NT hypertrophy was achieved more than 7 times more often in group 1 (30%) than in group 2 (4%), p = 0.028. While the size of the nasopharyngeal tonsil was maintained, 48% of patients in group 1 did not have block of the pharyngeal auditory tube orifices (vs 4% in group 2, p = 0.001). Five (22%) patients in group 2 had an increase in the degree of nasopharyngeal tonsil hypertrophy or the appearance of block of the pharyngeal auricular orifices (6/26%) between visits 2 and 3 (p = 0.026). Group 1 was statistically significantly more likely to achieve a complete therapeutic result (p < 0.0001). The proportion of patients who never had an acute respiratory infection during the follow-up period in group 1 was statistically significantly higher (81% vs. 35%, p = 0.0021). Conclusion. Inclusion of inosine pranobex (Normomed®) in therapy contributes to the achievement of a complete therapeutic result (marked and maximum clinical improvement of clinical picture against the background of absence of virus DNA isolation according to PCR-diagnostics) and reduction of propensity to recurrent respiratory infections in the majority of patients. Key words: adenoiditis, recurrent respiratory infections, herpes viruses, inosine pranobex, children