RU2420274C2 - Method of treating urogenital infection of lower parts of genital tracts in women - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to gynecology, and can be used in treatment of urogenital infection of lower parts of genital tracts in women. For this purpose carried out are per oral antibiotic therapy and additional irrigation with oxygenated solution of antimicrobial preparations for 1-3 min in volume 50-100 ml. Course constitutes 1-2 procedures per day for 3-7 days.

EFFECT: method ensures due to medication oxygenation quicker elimination of free and adhered opportunistic microorganisms of luminal and parietal vagina microbiota, acceleration of vagina epithelium recovery, multiplicity of reducing vaginosis recurrence by 2,6 times and reduction of said disease recurrence duration during 24 months.

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Description

The invention relates to the field of medicine, namely gynecology and urogynecology, and can be used to treat a bacterial infection of the vaginal space, including bacterial vaginosis.

Known methods for treating bacterial infections, inflammatory diseases of the pelvic organs in women and bacterial vaginosis by antibiotic therapy (Kubanova A.A. et al. 1996. - Vestnik dermatol. No. 2. - P.76-77; Tyutyunnik V.L. , 2001. - breast cancer. - T.9 - No. 6. - S.250-252; Kisina V.I. et al. - Gynecology. - 2003 - T.5. - No. 1. - S.32-35; Tikhomirov A.P. - Gynecology - 2000. - T. 2. - No. 6. - P.196-201; Voropaeva S.D., Consilium Medicum. - 2008. - V.10. - N1. - P.25 -31).

However, such methods are not always effective and do not exclude the development of side effects associated with a violation of the microbiocenosis in the vagina (Bragin L.E. et al. - Thes. Report. "Dysbacteriosis and eubiotics." - M., 1996. - P.8; Voropaeva S.D., 2008), as well as general reactions of the body in the form of allergic rashes on the skin and mucous membranes, the appearance of edema in the muscles and tissues (Ankirskaya A.S. Obstetrics and gynecology. - 1995. - No. 6. - P. 13. -16; Kira E.F. - St. Petersburg: Neva-Lux LLC. - 2001. - 363 C; Bondarenko V.M., Vorobyov A.A. - ZhMEI. - 2004. - No. 1. - P.84- 92).

The pathogenetic complex therapy using oxygen can be based on the correction of antioxidant protection (AOD) as a key mechanism that controls the metabolic restructuring of the body, which helps restore homeostasis. The property to induce AODs is possessed by ultraviolet radiation, laser, ozone, oxygen, and other oxidizing agents (S. Rilling, R. Wiebahn, 1985). The effect of oxygenated oxygen on the body and vaginal mucosa, in particular, is significantly milder compared to other physicochemical factors, and its ability to induce AOD is provided through the development of oxidative stress. The advantages of this factor also include the possibility of a more accurate dosage and control of the current dose.

Known methods for treating bacterial infections using microbiological therapy. Due to its effects on the immune system, metabolic processes and microflora, it is used as a concomitant treatment method (Rush K., Rush F., 2003).

The closest technical solution adopted for the prototype are the above-mentioned works - Tyutyunnik V.A., Kisina V.I., Voropaeva S.D. and etc.

From the works it is known that the use of antibacterial drugs serves to eliminate microbial infection.

The difference from these works is that a positive effect in the treatment of urogenital infection of the lower genital tract and bacterial vaginosis is achieved using oxygenated antiseptic solutions.

Thus, a method is proposed for treating urogenital infection of the lower genital tract of women by conducting antibacterial therapy, characterized in that they additionally irrigate the vaginal cavity with an oxygenated solution of antimicrobial agents for 1-3 minutes in a volume of 50-100 ml in a course of 1-2 procedures per day per within 3-7 days.

The objective of the invention is to increase the effectiveness of the treatment of urogenital infections of the lower genital tract of women due to:

1- activation of drugs using oxygen and their action on the luminal and parietal microflora of the vagina and cervical canal;

2- acceleration of transmembrane transfer of antibacterial agents and selective action on the parietal microflora adhered to the mucous membranes of the cervix and vagina;

3- the ability to achieve the antistatic effect of inflamed tissue for faster and easier removal of fibrinous films in closed natural cavities of the pelvic organs and accelerating the restoration of the epithelium of the vagina and cervical canal;

4- reduction of the main signs of bacterial vaginosis;

5- concomitant risk factors (various side effects in the form of allergic rashes on the skin and mucous membranes, the appearance of edema);

6-fold reduction in relapse of urogenital infection;

7- reducing the duration of recurrence of urogenital infection.

Treatment of urogenital infection in the control group was carried out using the traditional antibiotic therapy. At the same time, etiotropic antibacterial drugs were prescribed.

The treatment of patients of the main group was carried out by irrigation of the vaginal cavity with an oxygenated solution of drugs (metronidazole or chlorhexidine at a dilution of 1: 1000), selected for sensitivity to etiologically significant pathogens simultaneously in a volume of 50-100 ml 1-2 times a day for 3- 7 days. Oxygen therapy was carried out with aqueous solutions of antiseptics, passed through an oxygenator at a rate of 1-10 mg / l in statics under a pressure of 2 atm. The oxygenator was proposed by D.V. Yanshin (patent for the invention No. 2129869 dated 05.10.99). Oxygen fills the tank with the medium under a pressure of 0.2-0.4 atm along the dividing line existing in any hospital or health care facility.

The method of oxygen therapy was used in 24 patients whose age ranged from 38 to 53 years.

In this case, conventional methods of clinical and bacteriological diagnosis of the etiology of urogenital infection were used.

Assessment of the effectiveness of the treatment was carried out according to visual examination, colposcopic examination, visual inspection in the mirrors, bacterioscopy of native smears and bacteriological studies of microbial contamination of the vagina and cervical canal before treatment and 7 days after it.

Visual manifestations of the local sanogenic effect of the oxygenated aqueous solution on the course of the urogenital infection of the lower genital tract (NOPP) during vaginal sanitation were observed during the visit, as well as during microbiological control. The colposcopic picture represents inflammatory changes in the mucous membrane with edema, hyperemia, and sometimes with the presence of petechiae. It has been established that against the background of the above positive dynamics, it is possible to reduce or cancel the doses of antibiotics administered in connection with activation of the body's non-specific defense and a tendency to normalize bacteriological and immune status. Along with this, an improvement in the general condition of the body is observed and the level of quality of life increases.

After treatment, all patients showed an improvement in overall health, a statistically significant (P <0.01 and P <0.05) decrease in signs of inflammation and bacterial vaginosis (drawing).

Abundant discharge from the genital tract decreases from 77.3% of cases to 16.7% (P <0.05); the amine test is determined before treatment in 72.7% of cases and after treatment decreased to 8.3% (P <0.01). Discomfort in the vulva was observed in 63.6% of cases and after treatment it was 12.5% (P <0.05). Normalization of dysuric manifestations was noted - before treatment in 40.9% of cases and after - 4.1% (P <0.01). Visible mucous membranes of the vagina and cervix acquired a more natural color. Their hyperemia was recorded before treatment in 54.5% of cases and after that remained in 20.8% (P≤0.05). An increase in the pH of the vaginal discharge to a level of more than 4.5-6.0 was observed in 91.6% of cases before treatment and after treatment was determined only in 12.5% of cases (P <0.01).

The effectiveness of vaginal debridement with an oxygenated solution is also confirmed by microbiological studies. The data are presented in table 1.

Table 1 Microflora of vaginal discharge in patients with bacterial vaginosis before and after treatment with an oxygenated solution Gram stain of vaginal discharge Before treatment (n = 22) After treatment (n = 24) abs % abs % Key cells twenty 90.9 2 8.3 * Gardnerella fourteen 63.6 3 12.5 * Bacteroids 9 40.9 one 4.2 * Note: * - P <0.01 (in comparison with data obtained before treatment)

From the table it follows that with infection of the lower genital tract and BV before treatment, key cells were determined in 90.9% of cases, and after treatment they were detected only in 8.3% of cases. Gardnerella and bacteroids before treatment were 63.6% and 40.9%, and after treatment - 12.5% and 4.2%, respectively.

Statistically reliable indicators for the detection of various types of pathogens of the luminal and parietal microbiocenosis of the vagina were obtained during examination of patients before and after a course of treatment with oxygen therapy. The results of these studies are presented in table 2.

table 2 Indicators of the occurrence of various types of pathogens of the luminal and parietal microbiocenosis of the vagina of 24 patients before and after treatment with oxygen therapy Type of microorganism Enlightened microbiocenosis Parietal microbiocenosis before treatment after treatment before treatment after treatment abs % abs % abs % abs % Staphylococcus 12 19.6 four 6.5 *** 9 17.0 2 3.8 *** E. coli fourteen 22.9 3 4.9 ** fifteen 28.3 5 9.4 *** Klebsiella 10 16,4 2 3.3 *** 7 13,2 one 1.9 *** Proteus 6 9.8 2 3.3 *** four 7.5 3 5.7 *** Pseudomonas aeruginosa 8 13,2 one 1.6 ** 5 9,4 0 0 * Corinobacteria eleven 18.1 3 4.9 *** 13 24.6 2 3.8 ** Total strains 61 one hundred fifteen 24.5 * 53 one hundred 13 24.6 * Note: * - P <0.01; ** - P <0.05; *** - P> 0.05, the statistical significance before and after treatment is determined by the nonparametric method of “sign criterion”.

From the table it follows that after application of the course of oxygen therapy there is a change in the quantitative indicators of the vaginal luminal and parietal microbiocenosis.

When examining the vaginal discharge in its lumen microbiocenosis after a course of oxygen therapy, microorganisms were found that eliminated in a different percentage ratio. If, before treatment, pathogens: staphylococci, Escherichia coli, Klebsiella, Proteus, Pseudomonas aeruginosa and corynecobacteria isolated from patients with vaginosis amounted to: 19.6%; 22.9%; 16.4%; 9.8%; 13.2%; 18.1%, respectively, after treatment with oxygen therapy, the relative amount of these microorganisms was: 6.5%; 4.9%; 3.3%; 3.2%, 1.6% and 4.9%, respectively.

When examining this contingent of patients in the parietal microbiocenosis of the vagina before treatment, the number of these types of pathogens was: 17.0%; 28.3%; 13.2%; 7.5%; 9.4%; and 24.6%; after treatment - 3.8%; 9.4%; 1.9%; 5.7%; 0% and 3.8%, respectively.

Thus, in the vaginal luminal microbiocenosis, 61 biotopes of microorganisms were identified before treatment, the detection limit of which was from 9.8% to 22.9%, and after treatment this interval was from 1.6% to 6.5% of the selected 15 biotopes microorganisms.

With parietal vaginal microbiocenosis, 53 biotopes were isolated before treatment and after treatment with oxygen therapy, 13 pathogen strains were isolated, the detection limit of which was 7.5% -28.3% before treatment; after treatment, they were not detected or were from 1.9% to 9.4%.

According to our data, the use of antibacterial drugs oxygenated with a solution in clinical practice was accompanied by a lower risk of treatment failure in BV compared to traditional vaginal sanitation (hydrogen peroxide, furacilin, etc.) used before the main treatment. It should be noted that changes in the general analysis of blood in patients before and after treatment were nonspecific and poorly expressed. In addition to significant elimination of microorganisms, irrigation with an oxygenated solution of the vaginal cavity has an analgesic and anti-stress effect, eliminates discomfort in the vulva and improves the quality of life of patients. The rate of decrease in recurrence of BV was recorded 2.6 times: before treatment, it was 10.4 days, and after treatment - 3.9 days. A decrease in the duration of disease recurrence 1 month after treatment was observed in 91.6% of cases; after 3 months, it amounted to 87.5%; after 6 months - 79.2%; after 12 months - 70.8% and after 24 months in 62.5% of cases. The advantage of this method of treatment is the relative simplicity of its implementation in the presence of an oxygenator and the use of inexpensive and generally available solutions (chlorhexidine, dioxidine, metronidazole), which determined the pharmacoeconomic effect in a clinic

Clinical example: patient G.S. I., 48 years old, and.b. No. 58805, appealed to the day care center of the ZhK at Polyclinic No. 66, in October 2004 with complaints of copious vaginal discharge, an unpleasant fish smell. I had the conclusion of a PCR study with me, where lactobacilli are negative, the presence of Gardnerella vag. +; Mycoplasma hom. +, Mobiluncus c. +; Bacteroides +. On the day of treatment, a smear from the vagina and cervical canal was taken for the presence of microflora. Gram stain was smeared and microscopically stained with Gram stain, where “key” cells were found in large numbers, white blood cells in moderate numbers. Based on the available and performed examinations, the diagnosis was made: decompensated bacterial vaginosis. Etiotropic treatment was prescribed with a single daily vaginal irrigation with an oxygenated metronidazole aqueous solution. 5 days after the course of treatment, inoculation was performed with isolation and identification of parietal and luminal microflora. In the second smear: “key” cells were not found, white blood cells are single and single “pure” epithelial cells corresponding to the phase of the menstrual cycle. Bacteroids were completely absent. In the culture before treatment, the presence of opportunistic microorganisms, non-clostridial anaerobic infection was detected. After a course of oxygen therapy, a significant decrease in acinetobacter, E. coli was noted and Pseudomonas aeruginosa was completely absent. Already after 4 sessions of vaginal irrigation, an improvement was noted according to colposcopy and visual examination. The patient was prepared for surgery for multiple uterine fibroids, with subserous nodes from 2 to 10 cm in size. The operation was performed in December 2004 without opening the uterine cavity (conservative plastic surgery). On ultrasound - the size of the uterus along the anteroposterior wall - 46, width - 56, length - 58 mm; the uterine cavity is not deformed. B-I was discharged while maintaining menstrual function under observation. There are no complaints. The postoperative period is without complications.

Thus, the use of oxygen therapy in the complex treatment of bacterial infections by irrigation of the vaginal cavity leads to an improvement in the general condition of patients, reduction and more rapid disappearance of pain, dysuric disorders, increased efficiency, which affects the quality of life of patients, faster normalization of clinical and laboratory parameters . This allows you to reduce the dose of antibiotics administered; reduce the time of temporary disability of patients; reduce the percentage of complications, as well as increase the medical, social and economic effect of treatment. It should be noted the high profitability of the method of oxygen therapy when using it in outpatient practice. During the period of application of this method, we have proved its relevance and effectiveness. Oxygen therapy can be widely used by gynecologists who own this method.

Claims (1)

A method of treating urogenital infection of the lower genital tract of women by antibiotic therapy, characterized in that they additionally carry out vaginal irrigation with an oxygenated solution of antimicrobial agents for 1-3 minutes in a volume of 50-100 ml in a course of 1-2 procedures per day for 3-7 days.

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