RU2318515C1 - Method for treating patients for pulmonary tuberculosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out antibacterial therapy in standard mode. Wobenzyme and homeopathic drugs are additionally introduced into treatment course. Wobenzyme is given at a dose of 1 pill thrice a day 30 min before taking meals. Homeopathic drugs like Apis mellifika 6 China officinalis 6, Chelidonium mayus 6, Stannum 6, Sanguinaria Canadensis 6, Callium bronchicum 6, Carbo vegetabilis 6 are given at a dose of 5 grains thrice a day irrespective of food intake daily during the whole treatment course.

EFFECT: enhanced effectiveness of treatment; reduced risk of adverse side effects.

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Description

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

Pulmonary tuberculosis currently continues to be one of the most acute socio-economic problems. Despite the experience gained in the treatment of pulmonary tuberculosis patients, the problem of treatment effectiveness is the most relevant. In recent years, the number of patients with pulmonary tuberculosis has significantly increased due to drug-resistant strains of mycobacterium tuberculosis, which significantly reduces the effectiveness of treatment and in many cases is the cause of death.

The leading method in the treatment of pulmonary tuberculosis is antibiotic therapy with anti-TB drugs, which determines the main direction in the future in the fight against tuberculosis (order of the Ministry of Health of the Russian Federation of March 21, 2003, No. 109). However, many years of experience in the use of etiotropic therapy for tuberculosis allowed domestic and foreign researchers to note certain limits on the possibilities of chemotherapy in achieving a clinical effect. Modern chemotherapy for pulmonary tuberculosis has expanded and approved the pathogenetic direction in the treatment of patients, since an increase in the body's defenses creates favorable conditions for acting directly on the pathogen.

A disadvantage of the known methods of treatment is the rapid emergence of drug resistance of tuberculosis mycobacteria to these drugs, the appearance of various toxic reactions from the liver, gastrointestinal tract and nervous system, and weakening of the immune status. A particularly significant drawback is the insufficient bioavailability of ABPP in the lung tissue due to extensive fibrotic changes. Significant disadvantages include the development of dysbiotic disorders of the gastrointestinal tract, which leads to a further decrease in immunity.

All this makes us look for various new ways to treat pulmonary tuberculosis, which reduce the above disadvantages. Numerous studies aimed at studying the immunological state of patients with pulmonary tuberculosis in order to increase the body's defenses show that the use of drugs that correct the body's immune status create favorable conditions for influencing mycobacterium tuberculosis. However, the use of pathogenetic drugs aimed at regulating and restoring the body's homeostasis by affecting energy metabolism also has a significant positive effect in pulmonary tuberculosis. Conducted research of medical, scientific and patent literature identified various methods of treatment of pulmonary tuberculosis.

So in the work of L.A. Ivanov and P.M. Chuzhova “New aspects in the treatment of progressive pulmonary tuberculosis” (Materials of the scientific-practical conference “Modern pharmacotherapy: cytokines”, Minsk, 2000), a method for the treatment of pulmonary tuberculosis with inclusion in complex therapy of roncoleukin ^® .

In the work of A.S. Svistunov and B.V. Pinegin, “The use of the immunomodulator lycopide in the complex treatment of pulmonary tuberculosis” (Journal of Problems of Tuberculosis, 2002, No. 3, p.21-25), a method for treating tuberculosis using lycopid is described - a synthetic analogue of the component of the cell wall of all bacteria with pronounced immunomodulating properties.

In the work of V.V. Erokhin and V.Yu. Mishin: “Leukinferon in the treatment of acute progressive pulmonary tuberculosis” (Journal of Problems of Tuberculosis, 2004, No. 10, pp. 10-15) describes a method of treating tuberculosis using in the treatment of leukinferon.

By the order of the Ministry of Health of the Russian Federation No. 109 dated 03/21/03, “On the improvement of anti-TB measures in the Russian Federation” standard chemotherapy regimens for tuberculosis patients were defined, consisting of 2 phases with different tasks:

1) the intensive care phase is aimed at eliminating the clinical manifestations of the disease, maximizing the impact on the mycobacterium tuberculosis population in order to stop bacterial excretion and prevent the development of drug resistance, reduce infiltrative and destructive changes in organs;

2) the phase of continued therapy is aimed at suppressing the persisting mycobacterial population. It provides a further reduction in inflammatory changes and involution of the tuberculosis process, as well as restoration of the patient’s functional capabilities.

RF patent No.RU 2071326, IPC 6 A61K 33/00, 33/18 protects the "Method for the treatment of pulmonary tuberculosis", which provides for the additional introduction of homeopathic remedies: hydrastis in combination with calcari iodine, which improves the efficiency of treatment of patients.

RF patent No.RU 2197984 C1, IPC A61 protects "A method for the treatment of various forms of pulmonary tuberculosis, including those resistant to antituberculous chemotherapy," characterized in that an immunomodulator glutoxim is additionally introduced into the complex treatment with chemotherapy drugs.

RF patent No. 218834 C2, IPC A61 protected "Method for the treatment of acute progressive pulmonary tuberculosis", which provides for the introduction into the complex therapy of an immunomodulator roncoleukin.

The closest and taken as a prototype is the "Method for the treatment of the cavernous form of tuberculosis", protected by RF patent No. 2071325 C1 IPC A61, which provides for the introduction of homeopathic remedies into the adopted complex of prescriptions: Creosote, Stannum and Lahnantes.

The disadvantage of this method is the weak effect on the timing of the closure of the decay cavities, abacillation and the elimination of side effects from anti-TB drugs. This can be explained by the inaccurate orientation of the action of the homeopathic preparation on the interested pathological processes by the lack of impact on all links of the pathogenesis of pulmonary tuberculosis. So, lachnantes has a specific effect mainly on the brain and nervous system, stannum - on the nervous system, as well as on the respiratory system, but does not affect all links of pathogenesis.

The purpose of the invention: increasing the efficiency of treatment of patients with pulmonary tuberculosis by reducing the time of abacillation and closing of the decay cavities, preventing the occurrence of adverse reactions, reducing the duration of the patient’s hospital stay.

This goal is achieved by prescribing standard anti-tuberculosis chemotherapy regimens with the simultaneous inclusion of 1 tablet 3 times a day 30 minutes before meals and homeopathic remedies in treatment of Wobenzym - Apis Mellifika 6, China officinalis 6, Helidonium mayus 6, Stannum 6, Sanguinaria canadensis 6, potassium bichromicum 6, carbo vegetabilis 6 5 grains 3 times a day, regardless of food intake, daily throughout the treatment.

The choice of homeopathic medicines was determined by violations in the pathogenetic mechanisms of the formation of a particular symptom. This was achieved by the following exposure:

apis melifika - at the stage of exudation, edema and decay of the lung tissue;

quina officinalis - to restore immune disorders, disorders and prevention of toxic reactions from the liver, stomach and intestines;

helidonium mayus - drainage effect, elimination of toxins, restoration of liver function;

stannum - to restore the processes of dissimilation, the prevention of toxic effects on the nervous system;

sanguinarium canadensis - prevention of bleeding from the lung, restoration of the vascular wall of lung tissue;

potassium bichromicum - increased lung tissue regeneration, restoration of the immune status and respiratory tract mucosa;

carbo vegetabilis - to restore the processes of dissimilation, the state of the cardiac and vascular system, improve redox processes.

Selected homeopathic remedies have the ability to restore impaired homeostasis at the level of regulation of the higher parts of the central nervous system and the immunological state of the body and reduce the time for abacillation and closure of decay cavities.

The ability of Wobenzym to increase the concentration of antibiotics in the lesion enables us to use it in the pathogenetic therapy of pulmonary tuberculosis and to accelerate the resorption of infiltrative changes. The ability of wobenzym to improve microcirculation and the supply of oxygen and nutrients to tissues is used in destructive processes to accelerate repair. Given the development of secondary immunodeficiency in common tuberculous lesions, wobenzym is used to influence the immunological reactivity of the body, increasing the functional activity of macrophages and phagocytic activity of cells.

The method is as follows.

After examination and diagnosis, the patient is prescribed antibiotic therapy according to standard chemotherapy regimens. At the same time, in the complex treatment of pulmonary tuberculosis, they include Wobenzym 1 tablet 3 times a day 30 minutes before meals daily and a combination of homeopathic remedies: Apis Mellifica 6, Quina officinalis 6, Helidonium mayus 6, Stannum 6, Sanguinaria canadensis 6, Kalium bichromicum 6, Carbo vegetabilis 6 to 5 grains 3 times a day, regardless of food intake throughout the course of treatment.

Examples of the implementation of the claimed method.

1. Patient K., 50 years old, was admitted to an inpatient treatment in the pulmonary therapy unit of the State Regional Healthcare Institution “Tuberculosis Dispensary” in Rostov-on-Don for infiltrative tuberculosis S1, 2 of the right lung in the decay phase, MBT (mycobacteria tuberculosis) -.

Considers himself ill for about two months, when there were pains in the right half of the chest, cough with sputum. The patient went to the district clinic, after an R-examination, he was consulted by a TB doctor, diagnosed with infiltrative tuberculosis S1-2 of the right lung in the decay phase, MBT (Mycobacterium tuberculosis). The condition of the patient upon admission is moderate, the skin is pale. Food is moderate. Auscultatory - vesicular breathing is heard in the lungs, moist rales after coughing on the right under the collarbone. NPV (respiratory rate) - 22 in 1 minute.

Survey data at admission.

R-grams and T-grams - on the right in S1 against the background of pneumosclerosis, heterogeneous infiltration of lung tissue with a decay cavity up to 2.5 cm in diameter, with polymorphic foci around and a wide broncho-vascular "path" to the root of the lung.

Blood test - HB-154 g / l, Er-5.0 × 10 / l, L-7.8 × 10 / l, E-3, P-3, S-67, L-25, M-2, ESR-10 mm / hour.

Sputum analyzes twice (by bacterioscopy) - No CMC found.

Sputum culture (two cultures) gave a negative result.

Mantoux test with 2 TE PPD-L - 19 mm.

The patient received treatment according to the intensive phase 1 chemotherapy regimen. At the same time, Wobenzym was added 1 tablet 3 times a day 30 minutes before meals daily and homeopathic medicines - Apis Mellifika 6, China officinalis 6, Helidonium mayus 6, Stannum 6, Sanguinarium candensis 6, Kalium bichromicum 6, Carbo vegetabilis 6 each 5 grains 3 times a day, regardless of food intake throughout the course of treatment. Monitoring of treatment results was carried out throughout the course of combination therapy.

The data of the control examination (after 4 months).

R-gram and T - on the right in S1-2 pneumofibrosis, a group of clearly contoured foci. Apical - fibrous strand. In comparison with the R-gram and T-grams upon admission to the department - resorption of infiltration and densification of foci, closing the decay cavity.

Blood test - HB-136 g / l, Er-4.3 × 10 / l, L-6.3 × 10 / l, E-1, P-2, S-67, L-28, M-2, ESR-2 mm.

Sputum analysis twice (by bacterioscopy) - CMC (acid-resistant mycobacteria) not found.

Sputum culture (two cultures) gave a negative result.

Objectively: the patient's condition is satisfactory. Food is moderate, the skin is of normal color. No complaints. Auscultatory - vesicular breathing in the lungs, catarrhal phenomena are not audible. In satisfactory condition, the patient was discharged to outpatient treatment with a diagnosis of Infiltrative tuberculosis S1,2 of the right lung in the phase of resorption and compaction, MBT (Mycobacterium tuberculosis).

2. Patient I., 54 years old, was admitted to a hospital for treatment at the pulmonary therapy unit of the State Regional Healthcare Institution “Tuberculosis Dispensary” in Rostov-on-Don for disseminated pulmonary tuberculosis in the phase of infiltration and decay, MBT (Mycobacterium tuberculosis) .

Tuberculosis was diagnosed five years ago. He received treatment on an outpatient basis. Her health worsened two months ago, and therefore the patient was hospitalized. Complaints on admission for cough with sputum, shortness of breath, weakness, fever, weight loss.

Survey data at admission.

R-gram - in the lungs, against the background of diffuse pneumosclerosis, unevenly distributed polymorphic lesions in the upper sections of the drainage character, with decay cavities up to 2 cm in diameter, with wide vascular "paths" to the roots across all pulmonary fields. Domes of the diaphragm are deformed by commissures, the roots are fibrous, pulled up.

Blood test - HB-160 g / l, ER-5.2 × 10 / l, L-12.7 × 10 / l, E-3, P-6, S-69, L-20, M-2, ESR - 18 mm.

Sputum analysis twice (by bacterioscopy) - CMC (acid-resistant mycobacteria) not found.

Sputum culture (two cultures) gave a negative result.

The patient received treatment according to intensive phase 2 chemotherapy regimens. Simultaneously with the treatment were added: wobenzym 1 tablet 3 times a day 30 minutes before meals daily and homeopathic medicines - apis mellifika 6, quina officinalis 6, helidonium mayus 6, stannum 6, sanguinarium candensis 6, Kalium bichromicum 6, carbo vegetabilis 6 5 grains 3 times a day, regardless of food intake throughout the course of treatment. Monitoring of treatment results was carried out throughout the course of combination therapy.

The data of the control examination (after 4 months).

R-grams and T-grams - in S 1-3,6 of both lungs sections of cellular pneumofibrosis, against this background polymorphic foci with clear contours.

The roots of the lungs are fibrous, pulled up. In comparison with the roentgenogram at admission - resorption of infiltration, fresh foci and closure of the decay cavities.

Blood test - HB-128 g / l, Er-4.0 × 10 / l, L-6.7 × 10 / l, E-0.5, P-5, S-60.5, L-30, M-4, ESR-2 mm.

Sputum analysis twice (by bacterioscopy) - CMC (acid-resistant mycobacteria) not found. Sputum culture (two cultures) gave a negative result.

In satisfactory condition, the patient was discharged to outpatient treatment with a diagnosis of disseminated pulmonary tuberculosis in the phase of resorption and compaction, MBT (Mycobacterium tuberculosis).

Under our supervision there were 12 patients. Of these, 6 patients received anti-TB therapy according to standard chemotherapy regimens (control group). The second group consisted of 6 patients (the main group), in this group of patients Wobenzym and homeopathic preparations were added to the standard treatment regimen. As a result of treatment, an increase in the effectiveness of treatment was revealed in the main group: closure of decay cavities 3 times higher, 1.5 times abacillation.

A significant improvement in the general condition and the disappearance of the clinical signs of the disease occurred in most patients of the main group compared with the control group of patients. The results are shown in tables 1 and 2.

Table 1
The dynamics of the disappearance of clinical symptoms Clinical symptoms disappear Main group Control group After 1 month 2 months later In 3 months After 4 months Total After 1 month 2 months later In 3 months After 4 months Total Cough disappearance 6 people - one hundred% - - - 6 people - one hundred% 0 0 0 1 pax - 116.6% 1 pax - 16.6% Stopping sputum production 6 people - one hundred% - - - 6 people one hundred% 0 0 1 pax 16.6% 1 pax - 16.6% 2 pax 33.3% The disappearance of shortness of breath 6 people one hundred% - - - 6 people one hundred% 0 1 pax 16.6% 1 pax 16.6% - 2 pax 33.3% The disappearance of weakness 6 people one hundred% - - - 6 people one hundred% 0 0 1 pax 16.6% 2 pax 33.3% 3 pax fifty% The disappearance of catarrhal phenomena 6 people one hundred% - - - 6 people one hundred% 0 0 0 1 pax 16.6% 1 pax 16.6%

As can be seen from the table, all patients of the main group disappeared within one month of the clinical symptoms of tuberculosis - cough, sputum production, shortness of breath, weakness, catarrhal symptoms. Whereas in most patients of the control group, these symptoms persisted after 4 months. Thus, in patients receiving combination therapy, the disappearance of clinical symptoms and improvement in general condition occurs at an earlier time, which allows to reduce the length of their stay in the hospital and transfer to outpatient treatment.

table 2 The effectiveness of treatment of patients * Indicator Main group Control group After 1 month 2 months later In 3 months After 4 months Total After 1 month 2 months later In 3 months After 4 months Total Decay cavity closure - 2 pax 33.3% - 3 pax fifty% 5 pax 83.3% - 0 - 1 pax - 16.6% 1 pax - 16.6% Abacillation 2 pax 33.3% 4 pax 66.7% - - 6 people one hundred% 0 2 pax 33.3% 1 pax 16.6% 1 pax 16.6% 4 pax 66.5% * - the closure of the decay cavities was evaluated after 2 and 4 months.

As can be seen from the table, in all patients of the main group, abacillation occurred within two months, in the control group - after two months only 33.3% of patients were abacilated, after 4 months 66.5% of patients were abacillated. In patients of the main group, after 2 months, the decay cavities closed in 33.3% of cases, after 4 months in another 50% of cases. While in patients of the control group within two months the closure of the decay cavities did not occur, the decay cavities closed after 4 months in 16.6% of cases. Thus, faster closure of decay cavities and abacillation in patients receiving combination therapy can reduce the length of hospital stay. After 4 months, patients of the main group were transferred to outpatient treatment, while patients of the control group continued treatment in the hospital for 8-10 months.

The proposed method for the treatment of pulmonary tuberculosis patients can increase the effectiveness of treatment of pulmonary tuberculosis patients by reducing the closure of decay and abacillation cavities, as well as accelerate the disappearance of the clinical manifestations of the disease, improve the general condition of patients and shorten their hospital stay.

Claims (1)

A method of treating pulmonary tuberculosis, providing for antibiotic therapy according to standard modes, characterized in that in addition to the course of treatment from the first day, include Wobenzym 1 tablet 3 times a day 30 minutes before meals daily and homeopathic medicines - Apis Mellifica 6, quin officalis 6 , chelidonium mayus 6, stannum 6, sanguinarium canadensis 6, potassium bichromicum 6, carbo vegetabilis 6 5 grains 3 times a day, regardless of food intake daily for the entire treatment period.