The method of treatment of pulmonary tuberculosis

 

(57) Abstract:

The invention relates to medicine, pulmonology and can be used for the treatment of pulmonary tuberculosis. Enter IFN 3 Miu rectal 2 times a week in the days of anti-TB drugs throughout the course of antibacterial therapy by intermittent intravenous chemotherapy. This invention enhances the efficiency of the treatment on the background of reducing the toxic effects of drugs through the use of reaferona, which in turn allows you to reduce the dose rate of chemotherapy.

The invention relates to medicine, namely to Phthisiology.

Tuberculosis has a strong tendency to increase. A growing number of cases with severe forms of the disease: in a three-fold increase in the number of patients registered for the first time with the disease, 4-5 times with rapidly progressing polycavernoside processes. There is a high risk of death in TB patients. Especially brightly deterioration of the epidemiological situation on tuberculosis seen in Western-Siberian region, where the rapidly increasing number of patients with destructive processes. In 1988-1999, in Western Siberia for the first time is 1-2 years of treatment, including chemotherapy, surgery, and other methods noted in nearly half of the observations (44,5%). In General, the number of patients who have had chronization cavernous process, increased 6.4 times. This is despite the attempt of TB to rectify the situation for the vast majority of cases immediately 4-5 drugs short (9 - and 6-month) courses of chemotherapy. While not pay attention as to the sequence of medication and increased inactivation of isoniazid every second patient [1].

In this regard, increasing the relevance of improved methods of treatment of tuberculosis patients. The optimal method is intravenous drip of anti-TB drugs 2 times a week. Because anti-TB drugs, as antimetabolites, hurt enzyme systems not only of Mycobacterium tuberculosis, but also of the microorganism, the intermittent intravenous administration of anti-TB drugs used from the first days of treatment, provides a long-lasting and at the same time gentle effective treatment of patients [2].

One of the important causes for the rise in the incidence tubercu complex adverse social, economic and environmental factors. Immunodeficiency in terms of protein and vitamin starvation leads to increased aggressiveness of Mycobacterium tuberculosis since the weakened body is not able to resist the pathogen breeding virtually unrestrained at the lack of antibodies and reduced functional activity of tuberculosis immune cells [1, 2]. Therefore, at the present time, when there is increase in the incidence of tuberculosis and the number of patients with severe poorly-curable forms of the disease, chemotherapy alone without immune is not possible to achieve good results.

In the practice of Phthisiology currently uses a broad range of immunomodulating drugs (Likopid, drugs thymus, nukleinat sodium and others). There is a method of using human leukocyte interferon and interferon-alpha in the inhalation for the treatment of patients with different forms of tuberculosis [3, 4]. However, the inhalation method of administration of drugs does not allow to reach high concentrations in the serum, which is necessary for tuberculosis to achieve a therapeutic effect.

Experimentally dock is their long time in the serum compared to parenteral routes of administration [5]. However, the literature contains no information on rectal interferon treatment of patients with pulmonary tuberculosis.

Since 1981 in various diseases was conducted clinical trials of another type of interferon is recombinant alpha-2 (reaferona), but there is no literary guidance on the use of this drug in tuberculosis. All of the above testifies to the relevance of the issue of differential effects on the immune system of patients with pulmonary tuberculosis.

The proposed method for the treatment of tuberculosis of the lungs is to carry out the intermittent intravenous chemotherapy and the introduction reaferona 3 million UNITS rectal 2 times a week in the days of anti-TB drugs during the entire course of treatment. This method allows to increase the effectiveness of treatment and to have a beneficial effect on the immune system of patients with pulmonary tuberculosis.

The method is as follows.

Intravenous drip of anti-TB drugs are carried out in specially equipped treatment room, which thoroughly observed hygienic rules adopted for the contents of such premises. It has a couch and mm physician specially trained nurse to be informed of the possible complications arising from the derogation from the rules of procedures.

Cooked the medicinal mixture in the amount of 150-180 ml injected into a vein through a thin needle with a speed of 60 drops per minute. As mentioned, isoniazid before infusion at a dose of 12-14 mg/kg of the vials are transferred into sterile 0.9% sodium chloride solution, prepared in bidistilled water no later than 24 hours ago. Here we add 20 ml of 5% solution of kanamycin capsules for intravenous injection, the vial is connected disposable sterile system for intravenous infusion, vial is fixed on a tripod. If the treatment involves intravenous rifampicin, 3-4 injectable drug (450-600 mg) was injected into the vial with a sterile solution of 5% glucose 150-200 ml. Vial is fixed on the same tripod. Immediately after infusion isoniazid with kanamycin carry out intravenous drip rifampicin.

After 10-15 minutes, patients are placed in the rectal treatment. 3 million ME dry reaferona dissolved in 100 ml of physiological solution. The introduction is carried out after defecation or enemas through atraumatic catheter in a vial odalenih veins are not included in the portal vein of the liver, what prevents the rapid inactivation reaferona reticulo-endothelial system of the liver. “Targeted delivery of the drug into the lung. The penetration of the drug into the lymphatic system, rectum contributes to lengthening the life time of the drug in the body of the patient.

The first procedure is the introduction of half doses of drugs to test their endurance. If no adverse reactions occurred, the next day spend infusion with a full dose calculated on a body weight of the patient. In subsequent therapeutic procedures carried out 2 times a week. After infusion of the drug, the patients are transferred to the ward, where within 2-3 hours are in bed.

The total duration of the course of intravenous bactericidal treatments should not be less than 6-7 months (50-56 injections). During this time the patient receives only 52-56 g kanamycin, 30-50 g of isoniazid, 24-34 g rifampicin.

Clinical example.

Patient K., aged 34, a resident of Novosibirsk, Manager in a commercial organization. The above-average income. Lives with her mother in a two-room comfortable apartment.

Pain in acute: the rise of the temperature to 38 pain in the right half of the chest, kas 5 days I went to the doctor, after what has been revealed changes in the lungs. Within 2 weeks were in the pulmonary Department multidisciplinary hospital, received treatment claforan, metrogram. Double-spent pleural puncture; received in 200.0 ml of exudate protein content of more than 3 g/l with a predominantly lymphocytic composition and positive breakdown Rivalta.

In therapeutic clinic of the research Institute of tuberculosis received 11.05.01, presenting complaints of persistent pain in the right half of the chest, shortness of breath during physical activity, coughing, at temperatures up to 38C, sweats, constant fatigue.

Power low (height 167 cm, weight-53 kg), paleness of the skin. The NPV of 20 per minute. Dullness of the lung sound right lower angle of the scapula, the breath is not here. Over the rest of the lungs vesicular breathing. Heart sounds are clear, rhythmic. Pulse 80 beats per minute. HELL 100/60 mm RT. Art.

In General, the analysis of blood lymphocytosis 34%, elevated erythrocyte sedimentation rate of 56 mm/h. In the biochemical analysis of blood dysproteinemia: total protein - to 87.6 g/l, albumin- 44,5%, 1 - 6,3%, 2 - 8,7%, - 12,6%, - 25,3, albumin-globulin ratio of 0.8. Functional tests of liver transaminase activity, sedimentary samples without deviating from h is A.

In the study on the immune status of violations: the reduction of CD8 + T cells and an increase in immunoregulatory index (IRI). This was interpreted as a violation of the cellular immune response. In this regard, was appointed as IFN inducer cell immunity.

The radiological examination of the chest from 14.05.01: right intensive Subtotal shading, blending with the dome of the diaphragm with an oblique upper bound on the level 4 ribs. In C3 the focus with a diameter of 2.5 cm from the site of the collapse. On the left, mainly in C1 infiltrate focal structure associated with the root of the lung; there are lots of destruction.

The ECG recorded accelerated atrial rhythm with a heart rate of 83 in 1 min, signs of moderate changes in the myocardium. When spirographis study showed initial signs of violations of the bronchial passage.

Clinical diagnosis of Infiltrative tuberculosis of the upper lobes of both lungs in the phase of disintegration, the office is. Tuberculous pleural effusion on the right, the phase of exudation.

Started intermittently (2 times a week) treatment according to the scheme: 1.5 g of pyrazinamide inside, after 1 hour or intramuscular injection of 1 g of streptomycin, and after 30 minutes PR is combined with 450 mg rifampicin 200 ml of 5% glucose solution. Portability satisfactory. Against the backdrop of ongoing chemotherapy was appointed IFN. 3 million UNITS reaferona in 100 ml of saline was administered rectal drip method days of treatment with anti-TB drugs. Portability is also satisfactory.

During chemotherapy and treatment with IFN symptoms of intoxication cropped 3 weeks. Normalization of the erythrocyte sedimentation rate (10 mm/h), lymphocytes (23%) and protein fractions observed after 2 months. Radiology positive dynamics was observed within a month of starting treatment, and after 5 months right in C3 was determined small conglomerate focus with fibrous bands, decreasing in size due to the seal; it is surrounded by small, thick-walled homes. Left upper lobe on the background of significant fibrosis many different-sized, thick-walled homes. The patient was treated on an outpatient basis. By this time there were obtained repeatedly negative results of sputum smear microscopy and negative results of tests for mycobacteria.

During the examination of the immune status in the dynamics of the normalized CD8 + T-lifecity, decreased IRI. After 10 months the patient was transferred under the supervision of the IDA 50 g rifampicin 37 g, streptomycin 83 g, pyrazinamide 122,

Diagnosis at discharge: Infiltrative tuberculosis of the upper lobes of both lungs in the phase of resorption and seals, the office is. Tuberculous pleural effusion on the right, the phase of resorption.

Difficulties in curing the patient K. was in its bilateral process (focus with a plot of decay surrounded by lesions to the right, infiltrate, associated with the root of the lung to the left), right-sided pleural effusion. Antibacterial therapy in combination with IFN resulted in resorption of infiltrates and foci, the elimination of destruction and pleural overlays. Patient 5 months was in the hospital 5 months were outpatients four anti-TB drugs and IFN intermittently mode 2 times a week. Achieved a complete clinical well-being. Complications during treatment.

Under our supervision there were 18 patients. The average age amounted to 30 years. They all received treatment with IFN in the background of antibacterial therapy of pulmonary tuberculosis within 6-10 months. When assigning reaferona we focused on indicators of immunological indexes. The comparison group consisted of 20 patients in the same who is uppy intoxication symptoms were controlled in the early stages (up to 2 weeks from start of treatment), faster came sputum smear conversion (up to 2 months), it was noted early positive radiographic dynamics of the process (early resorption infiltrative changes to 1-month therapy), there was normalization of immune status.

Thus, the proposed method of treatment of pulmonary tuberculosis has the following advantages:

- contributes to the favorable clinical course of tuberculosis increases the effectiveness of treatment, helps to normalize the body's immune system;

- this method of treatment is the controlled treatment reduces drug load on the body;

- application reaferona eliminates drug complications of TB treatment;

when rectal the way reaferona not found adverse reactions to the drug;

- use reaferona helps reduce the incidence of viral and infectious diseases, previously led to worsening of the underlying pathological process;

- this method can be applied in outpatient practice.

Sources of information

1. Arsov, I., Krasnov C. A., Borovinskaya T. A., Potato the command method. - Novosibirsk, 2001. - 124 S.

2. Arsov, I., Borovinskaya T. A. Antibacterial therapy of pulmonary tuberculosis. - Novosibirsk, 1994. - 153 C.

3. L. B. Khudzik, T. Y. Salina, L. E. Paroline. Immunotherapy of respiratory TB// Probl. TB - 1998. - N-6. - S. 23-26.

4. Giosue, S., Casarini M., Alemanno L. Galluccio, G., P. Mattia, Pedicelli G., Rebek L., Bisetti A., Ameglio F //Am J Respir Crit Care Med. - 1998.- V. 158.- P. 1156-1162.

5. Babayants A... Malinovskaya Centuries, Meshkov E. N. The pharmacokinetics of interferon in a rectal//Virology - 1986. - N 1. - S. 83-84.

The method of treatment of pulmonary tuberculosis by carrying out the intermittent intravenous chemotherapy, characterized in that it further injected IFN 3 Miu rectal 2 times a week in the days of anti-TB drugs during the course of antibacterial therapy.

 

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FIELD: medicine, anesthesiology-resuscitation, infectology, detoxication.

SUBSTANCE: the innovation suggested interrupts infectious-toxic shock, moreover, after that it is necessary to prescribe peroral intake of Reaferon-EC-Lipint at the dosage of 10000 - 15000 U/kg. Then one should sample patient's blood to obtain leukocytes to be washed and diluted in 0.9%-NaCl solution, activated due to incubation with immunophan and intravenously injected for a patient. Then comes peroral intake of Reaferon-EC-Lipint at the dosage of 10000 - 15000 U/kg once daily for 5 d. The innovation enables to decrease the number of complications and lethality due to decreasing immunodeficiency.

EFFECT: higher efficiency of therapy.

3 ex, 1 tbl

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