RU2254864C1 - Method for treatment of acute nonspecific catarrhal conjunctivitis - Google Patents

Abstract

FIELD: medicine, ophthalmology.

SUBSTANCE: method involves washing out the conjunctival sac with 0.03% sodium hypochlorite solution that is carried out 1 h before instillation of antibiotic. This washing out the conjunctival sac with sodium hypochlorite and antibiotic instillation is carried out 4 times per a day for 4-7 days. Invention promotes to reducing diseases time based on accelerated elimination of pathogens.

EFFECT: improved method for treatment.

2 cl, 2 tbl, 2 ex

Description

The present invention relates to medicine, namely to ophthalmology, and can be used in clinical practice in the treatment of acute staphylococcal and streptococcal conjunctivitis.

According to the epidemiological analysis, patients with inflammatory eye lesions rank first among outpatients (40.2%), amounting to about 16 million people per year in the Russian Federation. Up to 80% of cases of temporary disability, up to 50% of hospitalizations and up to 10-30% of blindness are associated with inflammatory eye diseases (A.M. Yuzhakov, V.P.Bykov, I.D. Zyurnyaeva, M.G. Godogze. New perspectives in the treatment of intraocular infection // West. Ophthalmol. - 2000. - No. 2. - P.20-22; Yu.F. Maychuk. New in the epidemiology and pharmacotherapy of eye infections // Clin. ophthalmol. - 2000.- T.1 , No. 2. - S.48-51). A distinctive feature of the course of inflammatory eye diseases at the present stage is an increase in the proportion of their protracted and chronic forms that are not amenable to standard antibiotic therapy due to the polyvalent resistance of microorganisms to the antimicrobial agents used (E. N. Indeykin. Monomycin for purulent eye diseases // Ophthalmol. 1975. - No. 8. - S.594-596; Yu.F. Maychuk. Eye infections // Rus.Med. Journal. - 1999. - T.7, No. 1. - S.16-19).

Therefore, the treatment of purulent-inflammatory eye diseases currently remains an urgent medical and social problem.

It is known to use antiseptic agents (oxidizing agents, acids, salts of heavy metals, silver preparations, dyes, etc.) externally for flushing purulent discharge or in the form of eye drops in the treatment of acute nonspecific catarrhal conjunctivitis. In particular, ethacridine lactate (rivanol). Rivanol has an antimicrobial effect, mainly in infections caused by coccal flora. The drug is low toxic.

With abundant purulent discharge, rivanol is prescribed for frequent washes at a dilution of 1: 5000. Eye instillation is performed several times a day with a solution of rivanol in the same dilution.

The disadvantage is that the aqueous solution of revanol is unstable, especially in the light (becomes brown), so you should use only freshly prepared solution, which limits its use (M.D. Mashkovsky. Medicines. M .: Medicine. - T2, 1988. - S.409).

A known method of using a 2% solution of boric acid. This solution manifests itself as an antibacterial, antifungal and astringent. When instilling or washing eyes, boric acid solution coagulates proteins of microbial cells.

The disadvantage of this method is that the drug is absorbed through the mucous membranes, penetrates many organs and tissues and can accumulate in them. It is excreted slowly (with repeated administrations it accumulates). It has a weak irritating effect on granulating tissues. When absorbed, it penetrates especially well through damaged skin and mucous membranes, causing systemic toxic effects. In addition, the method is not effective enough (Register of medicines. Encyclopedia of drugs. 2000. - S.154-155).

For the prototype, we adopted a method for the treatment of acute bacterial conjunctivitis with copious purulent discharge by washing the conjunctival cavity with a 2% aqueous solution of boric acid and instillation of a 0.3% solution of gentamicin sulfate (V.I. Morozov, A.A. Yakovlev. Pharmacotherapy of eye diseases. M .: Medicine, 2001 .-- 56-57).

Disadvantages: the same as in the previous analogue and side effects from the use of an antibiotic.

Tasks: increasing the effectiveness of treatment of non-specific catarrhal conjunctivitis, eliminating side effects.

The technical essence of the invention lies in the fact that in the complex of therapeutic measures, including the use of an antiseptic and antibiotic, in acute staphylococcal or streptococcal conjunctivitis, 1 hour before instillation of the antibiotic, the conjunctival sac is washed with a 0.03% sodium hypochlorite solution.

The reproducibility of the method is not in doubt, since well-known equipment and a process accessible to medical personnel are used. A solution of sodium hypochlorite in a concentration of 0.03% is obtained by electrolysis of an isotonic sodium chloride solution on an electrochemical detoxification apparatus of the body EDO-4 in automatic mode.

Sodium hypochlorite is an oxidizing agent and is widely used in purulent surgery. Pharmacological action - disinfectant, antiseptic, antimicrobial and detoxification. By the decision of the pharmacological committee of the Ministry of Health of Russia dated 09.07.92 (protocol No. 12) it is allowed to use a solution of sodium hypochlorite in dosage form at a concentration of 0.06% for intracavitary and external use. The Register of Medicines (Encyclopedia of Medicines. 2002. - P.900) says that at this concentration it is necessary to avoid getting the drug in the eyes and there are indications that when using the medicine in otorhinolaryngology, when instilling the nose and gargling, one should dilute it with water 1: 1 . We conducted an experimental study on 100 healthy rabbits (200 eyes) to study the effect of instillations of various concentrations of sodium hypochlorite on healthy eye tissue. According to an ophthalmological examination, morphological and morphometric studies, it was found that the effect of sodium hypochlorite on the rabbit's eyes, both single and multiple, at concentrations of 0.02-0.06% does not cause changes in intraocular pressure; concentrations of 0.03% and 0.02% do not reduce the sensitivity of the cornea and do not cause clinical and morphological changes in the tissues of the conjunctiva and cornea (A.I. Eremenko, E.A. Petrosyan, Z.Zh.Al Rashid. The possibility of using sodium hypochlorite as an antimicrobial agent in ophthalmic practice // Kuban Scientific Medical Invest. - No. 3 (64), 2003. - P. 24-25).

The method is as follows.

First, the conjunctival sac is washed with a 0.03% sodium hypochlorite solution, after 1 hour, 1 drop of a 0.5% gentamicin sulfate solution is instilled. Rinsing with sodium hypochlorite solution and instillation of the antibiotic is carried out 4 times a day under ophthalmological control until the inflammatory process subsides, mainly within 5-7 days.

We experimentally proved the effective effect of conjunctival sac washing with a 0.03% sodium hypochlorite solution in the treatment of conjunctivitis in 60 rabbits (120 eyes). The first series of experiments was conducted with staphylococcal conjunctivitis, the second - with streptococcal, 30 rabbits in each series.

A model for studying the effect of sodium hypochlorite on the inflammatory process in the conjunctival sac was conjunctivitis, reproduced by instillation in a healthy eye of 2 drops of a suspension of a one-day culture of Staphylococcus aureus 209 P or Streptococcus pyogenes culture. Two days after infection, when conjunctivitis developed with abundant purulent discharge, rabbits were randomly divided into 2 groups of 15 animals (30 eyes) in each series of the experiment for subsequent comparison.

In group 1, the complex of therapeutic measures included: first, washing the conjunctival sac with a 0.03% sodium hypochlorite solution, after 1 hour, instillation of a 0.5% gentamicin sulfate solution, 1 drop in both eyes. Washings with sodium hypochlorite solution and instillation of an antibiotic were done 4 times a day. In the 2nd group, therapy was carried out: washing with a 2% solution of boric acid 4 times a day in combination with instillations of a 0.5% solution of gentamicin sulfate 1 drop 4 times a day.

When evaluating the therapeutic effect of sodium hypochlorite, the timing of the disappearance of purulent discharge and the remission of the inflammatory reaction was taken into account.

Table 1 The dynamics of the pathological process in groups of rabbits with simulated conjunctivitis (in days, M ± m) Groups Number of eyes Duration of disappearance The timing of the remission of the inflammatory reaction Staphylococcal 1 thirty 4.00 ± 0.09 * 5.00 ± 0.09 * 2 thirty 5.13 ± 0.14 6.33 ± 0.17 Streptococcal 1 thirty 4.67 ± 0.12 * 5.92 ± 0.13 * 2 thirty 6.71 ± 0.19 8.21 ± 0.21 Note: * - p <0.05 between groups.

After the completion of experimental studies, the proposed method was tested on 20 patients with acute nonspecific catarrhal conjunctivitis, who applied to the emergency ophthalmology center at the Department of Eye Microsurgery of the City Clinical Hospital No. 3 of Krasnodar.

table 2 Terms of treatment of nonspecific purulent conjunctivitis (in days, M ± m) Evaluated Criteria 1 group n = 20, (26 eyes) 0.03% sodium hypochlorite solution + 0.5% gentamicin solution 2 group n = 20, (23 eyes) 2% solution of boric acid + 0.5% solution of gentamicin Age (years) 40.9 ± 2.3 44.1 ± 3.3 Sick before going to hospital 2,50 ± 0,12 2.15 ± 0.16 Purulent discharge period 2.71 ± 0.07 4.75 ± 0.20 * Treatment period 3.96 ± 0.08 6.10 ± 0.25 * Total duration of the disease 6.46 ± 0.16 8.25 ± 0.40 * Note: * - p <0.05 between groups.

The table shows that in all patients, the periods of purulent discharge, treatment and the total duration of the disease were less than with the treatment method of the prototype.

Example 1: Outpatient card No. 5681. A 47-year-old patient G. turned to an emergency ophthalmologic center with complaints of redness of the left eye, pain and purulent discharge, constant lacrimation. Ill 2 days ago acutely. First, in the morning, “combed”, then the eye reddened, purulent discharge appeared in the evening, and after a day turned for medical help. On an ophthalmological examination, a moderately expressed injection of the conjunctiva of the left eye. Moderately expressed purulent discharge. The eyelid conjunctiva is edematous with microhemorrhages in the follicles. The cornea is transparent. The front camera is average. Pupil 3 mm. Optical media are transparent. The fundus is normal. Given the patient’s complaints, history and data of an ophthalmological examination, the patient was diagnosed with Acute purulent conjunctivitis of the left eye. For microbiological examination, scraping and purulent discharge from the conjunctival sac was taken. The patient was rinsed with a conjunctival sac with a 0.03% sodium hypochlorite solution and an hour later with the installation of a 0.5% gentamicin solution. Flushing and instillation was carried out 4 times a day. On the third day from the start of treatment, the purulent discharge disappeared. On the fourth - no signs of an inflammatory reaction were noted. The treatment is canceled. Three days later, a microbiological analysis was obtained. The patient isolated Streptococcus pyogenes, sensitive to chloramphenicol, gentamicin and cephalexin. Final diagnosis: Acute catarrhal streptococcal conjunctivitis of the left eye. The total duration of the disease was 6 days, antibacterial treatment was 4 days.

Example 2: Outpatient card No. 26600. Patient A., 45 years old, turned to the emergency ophthalmological aid center with complaints of redness of the right eye, pain, purulent discharge, a feeling that something had got into the eye. Ill 2 days ago acutely. The right eye turned red, began to itch, later purulent discharge appeared, a day later sought medical help. During an ophthalmological examination, a moderately expressed conjunctival injection of the right eye. Moderate suppurative discharge OD. The conjunctiva of the eyelids is edematous without hemorrhages in the follicles. The cornea is transparent. The front camera is average. Pupil 3 mm. Optical media are transparent. The fundus is normal. Given the patient’s complaints, anamnesis and data of an ophthalmological examination, the patient was diagnosed with Acute purulent conjunctivitis of the right eye. For microbiological examination, scraping and purulent discharge from the conjunctival sac was taken. The patient was washed conjunctival sac with a 2% solution of boric acid, followed by instillation of a 0.5% solution of gentamicin. Flushing and instillation was carried out 4 times a day. On the fifth day from the start of treatment, the purulent discharge disappeared. At the sixth, there were no signs of an inflammatory reaction. The therapy was completed. On the tenth day, a microbiological analysis was obtained. Patient isolated Streptococcus pyogenes, sensitive to chloramphenicol, gentamicin, tetracycline and cephalexin. Final diagnosis: Acute catarrhal streptococcal conjunctivitis of the right eye. The total duration of the disease was 7 days, antibiotic therapy - 6 days.

When using the method allows to reduce the treatment time for acute nonspecific catarrhal conjunctivitis.

The method is recommended for widespread use in practical health care.

Claims (2)

1. A method of treating acute nonspecific catarrhal conjunctivitis, including the action of an antibiotic, characterized in that 1 hour before instilling the antibiotic, the conjunctival sac is washed with a 0.03% sodium hypochlorite solution. 2. The method according to claim 1, characterized in that the washing of the conjunctival sac with sodium hypochlorite and instillation of the antibiotic is carried out 4 times a day for 4-7 days, and the instillation of the antibiotic can be reduced according to indications.