RU2357745C1 - Method of pulmonary tuberculosis treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly phthisiatry, and can be applied in pulmonary tuberculosis treatment. Method involves peroral administration of oxymethyluracil (OMU) in amount of 0.5 g twice per day for 10 days in addition to traditional antibacterial therapy and bacrisporin probiotic.

EFFECT: OMU application together with bactisporin allows for accelerated elimination of mycobacteria and inflammation reduction in foci, amplified immunomodulating effect of bactisporin due to oxymethyluracil effect on functional metabolic activity of blood phagocytes.

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Description

The invention relates to medicine, namely to phthisiology and immunology, and can be used in the treatment of pulmonary tuberculosis of varying severity.

Improving the treatment of tuberculosis, mortality from which, along with neoplasms and cardiovascular diseases, is one of the first places, continues to be a serious problem of modern medicine. The main method of treating pulmonary tuberculosis is still etiotropic therapy in the form of a massive long-term administration of antimicrobials, mainly antibiotics, which can cause dysbiotic phenomena in patients that need to be corrected. During tuberculosis, various immunopathological manifestations take place, including those associated with specific treatment, which is why immunotherapy should be one of the important components of the accompanying therapy for infection.

The prototype of the present invention is a method for the treatment of tuberculosis, which consists in the use of the probiotic preparation Bactisporin (BS) in a complex therapy for tuberculosis patients containing a live culture of bacteria Bacillus subtilis ZN [Patent RU 2219939, 2003]. The BS solution is administered orally at least 4 doses 3 times a day 30 minutes before taking antibiotics or chemotherapy for 3-5 days, then 1 dose 2 times a day 30 minutes before taking antibiotics or chemotherapy for 10-15 days. The method provides stimulation of regenerative processes in the focus of inflammation and increased antimycobacterial effect.

In the treatment of pulmonary tuberculosis patients with the accompanying therapy of BS, in addition to the main therapeutic effect (a corrective effect on the dysbiosis that forms during antibiotic therapy), it has a certain immunomodulating effect [R. Gismatov. The immunomodulatory effect of bactisporin in the treatment of pulmonary tuberculosis. Dis ... cand. honey. sciences. - Ufa, 2004. - 97 p.]. However, the immunomodulatory effect of BS is manifested by stimulation of the mechanisms of immunogenesis associated with pro-inflammatory effects that can temporarily worsen the general condition of the patient. In view of this, there is a need for a certain correction of the effect of the treatment on the immune status of the patient.

The task of the invention is to improve the method of complex treatment of tuberculosis using the drug Baktisporin.

The technical result when using the invention is the correction and strengthening of the immunomodulatory effect of Bactisporin, reducing the duration of treatment.

The specified technical result is achieved due to the fact that in a method that includes traditional antibacterial therapy and the administration of the probiotic Bactisporin, oxymethyluracil is additionally administered orally at a dose of 0.5 g twice a day for 10 days of treatment.

The proposed method of treatment is as follows. The course of treatment is prescribed drugs of traditional antibiotic therapy and BS for the treatment of tuberculosis of varying severity. In addition, two oxymethyluracil tablets (0.5 g of the drug per dose) are administered twice a day after a meal for 10 days of treatment.

The immunomodulating drug oxymethyluracil under the trade name Immureg (IM) has a minimum range of contraindications for use (individual intolerance), and, in addition to the immunostimulating effect, has an anti-inflammatory, detoxifying effect, is able to enhance tissue repair processes [D. Lazareva, E. Alekhine E. K., Plechev V.V., Timerbulatov V.M., Plecheva D.V. Immureg. Ufa, 2004. - 104 s]. Immureg enhances and corrects the immunomodulatory effect of BS, due to which the treatment efficiency is increased and the treatment time for tuberculosis is reduced.

The tests were conducted on the basis of the medical institution UE 394/19 of the Federal Penitentiary Service of the Ministry of Justice of the Russian Federation in the Republic of Bashkortostan. For the tests, volunteers were selected - 80 patients with active pulmonary tuberculosis who were admitted to places of detention for serving their sentences in the period 2005-2006. In accordance with existing orders, the diagnosis was carried out by clinical and radiological methods, as well as by microbiological examination with the registration of the presence (BK +) or absence (BK-) of mycobacteria in sputum. All diagnostic measures were carried out in accordance with currently adopted regulatory documents.

In all patients, the therapy was carried out with the traditional prescription for the treatment of tuberculosis chemotherapy drugs in accordance with the approved standards [Tuberculosis: A Guide for Physicians. / Ed. A.G. Khomenko. - M., 1996. - 493 s]. In parallel with the main treatment, in the control group of 40 patients, along with the main treatment, BS was prescribed orally in the form of a suspension at a dose of 1.8 million units three times a day, for 5 days and then until the end of the course of treatment - twice a day. In a test group of 40 patients, in addition to this treatment, an additional two tablets (0.5 g of the drug per dose) were used twice a day for 10 days of treatment as an immunomodulator. Evaluation of the effectiveness of treatment was carried out in dynamics according to the results of clinical and laboratory examination of patients, including a panoramic x-ray of the chest organs and bacteriological examination of sputum for bacterial excretion of mycobacterium tuberculosis, carried out before and in the dynamics of complex treatment. In all patients, in the process of treatment, the immune status was assessed using generally accepted methods [Petrov R.V., Khaitov P.M., Pinegin B.V. et al. Evaluation of a person’s immune status during mass examinations // Methodological recommendations for scientists and medical practitioners (developed by the Institute of Immunology of the Ministry of Health of Russia). - Immunology. - 1992. - No. 6. - S. 51-52.].

During the study, during a clinical examination of patients among patients receiving accompanying therapy with BS and BS + MI, not a single case of deterioration in well-being from the use of drugs was recorded.

When studying the immune status of patients during treatment (Table 1), it was found that the additional inclusion of an immunomodulator IM in the accompanying therapy led to the fact that in patients of this group, in comparison with the control group, the average white blood cell count returned to normal, but was higher than in the group of patients receiving only BS. At the same time, the concentration of circulating lymphocytes, mainly due to T (CD3 +) - lymphocytes, while using MI remained elevated and was greater than that with therapy with BS. The content of natural killers after using BS + MI normalized, but did not increase, as after treatment with only BS. The appointment of MI had the most significant effect on the indicators of the functional and metabolic activity of blood phagocytes: it removed the increase in the number of active phagocytes caused by the BS (decreased phagocytic index) with a certain increase in the intensity of phagocytosis processes (increase in the phagocytic number), normalized the level of spontaneous activation of oxygen-dependent phagocyte metabolism and, at the same time, significantly increased the level of its activation induced by the process of phagocytosis in patients. In general, the above effects of the influence of MI can be characterized as an increase in the processes of immunogenesis (stimulation of leuko- and lymphopoiesis, T-link of the immune system) and balancing the activation of phagocytic defense mechanisms.

In a clinical evaluation of the effectiveness of the results of complex therapy using BS and BS with MI, the following data were obtained. The additional use of MI contributed to a significant improvement in the clinical and laboratory indicators of the condition of patients after the first course of treatment (Table 2) in the form of an increase in the number of patients with positive dynamics of x-ray changes in the foci of tuberculosis and a decrease in the number of patients with persistent excretion of mycobacteria with sputum. The number of patients was also reduced with the preservation of systemic signs of the inflammatory process during treatment - increased body temperature and leukocytosis in the blood.

According to the results of a comprehensive clinical examination, in determining the dynamics of treatment in patients over the course of a year, the effectiveness of supplementing the accompanying therapy of BS with IM preparation was also established (Table 3) - the number of patients requiring repeated courses of complex therapy decreased, the frequency of transferring patients to dispensary observation groups increased ( GDU) from GDU 1 (active tuberculosis) to GDU 2 (tuberculosis in the remission stage) and GDU 3 (cured tuberculosis), complete cure of patients (transfer from GDU 1 to GDU 2 to GDU 3), and juice was observed aschenie average time of healing.

Thus, the use of immunomodulator MI in the accompanying therapy with the probiotic BS additionally stimulated the T-lymphocytic link of the immune system, exerted a stabilizing effect on the phagocytes and caused an increase in their antimicrobial potential. The clinical effect was accompanied by accelerated elimination of mycobacteria, more rapid removal of inflammatory phenomena in the foci, and ultimately a reduction in the timing of the reverse development of the inflammatory process and recovery of patients.

The invention is illustrated by the following examples.

Example 1

Patient Z., 60 years old, first became ill with pulmonary tuberculosis in 1976. Previously, he was treated in a TB dispensary in the community. He was admitted for treatment on August 23, 2006, and was diagnosed with "Infiltrative tuberculosis of the upper lobe of the right lung in the decay phase of CD (-) GDU 1A." Complaints at admission: dry cough, weakness, sweating. From the moment of admission, therapy with pyrazinamide, rifadin, ethambutol, tubazide was prescribed; from 04.01.2006, a probiotic BS and an immunomodulator for MI were prescribed according to the specified scheme.

Upon admission to the chest radiograph on December 30, 2006: "In 81, S2 there is no homogeneous focus of infiltration with decay cavities up to 3 cm in diameter, different foci." When studying the results of complex treatment on a panoramic radiograph of the chest from 02/12/2006: "Current scarring of the decay cavities."

Example 2

Patient M., 36 years old, has been suffering from pulmonary tuberculosis since 1999. Previously, he was treated in the October PDD, and was observed according to the GIA VIIA.

02/11/2003 in the surgical department of the Republican hospital UIN carried out surgical treatment: "Resection of segments S1 and 82 of the upper lobe of the left lung."

He was admitted for treatment on November 19, 2006, and was diagnosed with "Infiltrative tuberculosis of the upper lobe of the left lung of CD (+) GDU 1A, late relapse. Polycystic disease of the upper lobe of the left lung."

Complaints at admission: dry cough, sweating, weakness. From January 30, 2006, against the background of therapy with metazide, pyrazinamide, ethambutol, a probiotic BS and an immunomodulator IM were prescribed according to the indicated scheme.

Upon admission to the chest radiograph on December 30, 2006: "In 8S, 82/0 there are petrified foci. In O / 8 \ +2, there is a subpleural inhomogeneous focal shadow with decay cavities of 0.5-0.7 cm in diameter." When studying the results of complex treatment on a panoramic radiograph of the chest from 02/12/2007: "Moderate resorption of infiltration while maintaining decay cavities."

Thus, it was found that the appointment of a probiotic BS and an immunomodulator MI together with antibiotic therapy for tuberculosis is a more effective and faster way to treat tuberculosis.

Claims (1)

A method of treating pulmonary tuberculosis, including conventional antibacterial therapy and the administration of a probiotic bactisporin, characterized in that it is additionally administered oxymethyluracil in a dose of 0.5 g twice a day for 10 days of treatment.