Method for treatment of pulmonary tuberculosis

FIELD: medicine, phthisiology.

SUBSTANCE: in early period the preparation "Yantar-antitoks" is used in the dose 0.5 g, 3 times per a day for one month in addition to the conventional antituberculosis therapy. Invention promotes to elimination of symptoms associated with the total intoxication, resorption of focus-infiltration changes, elimination of destructions and ceasing secretion of microorganisms for shorter periods. Invention can be used in treatment of pulmonary tuberculosis.

EFFECT: improved method for treatment.

4 tbl, 1 ex

 

The method relates to medicine, namely to Phthisiology.

The main and indispensable component of the modern approach to the treatment of tuberculosis remains intense and prolonged chemotherapy [1]. However, the effectiveness of the treatment is largely limited by the high frequency of adverse reactions and intolerance to anti-TB drugs, often due to their hepatotoxicity [2, 3, 4]. The liver is the body, providing energy and plastic body needs, performing basic detoxification function, protect the body from environmental aggression of the environment, including endogenous associated with the treatment of many diseases, since the metabolism of most drugs occurs in the liver [5].

For these reasons, there is still a problem of correction of hepatotoxicity of antituberculosis drugs by means of pathogenetic effects. One of the ways to prevent and eliminate hepatotoxic reactions that occur when specific therapy in patients with pulmonary tuberculosis is the use in the treatment of hepatic [6]. The group of hepatoprotectors very heterogeneous and includes substances of different chemical groups with opposite effects. Currently in clinical practices successfully used Essentiale Forte (Essentiale N), asslover Forte, Heptral, ursodeoxycholic acid. They all have cytoprotective, antifibrotics, choleretic, anti-oxidant effects [7]. However, these drugs are expensive. Given that TB are mostly people with low income is a clear need for economic availability of hepatoprotectors. In connection with this important study on the possibility of using new, not less effective, but cheaper medicines, protecting the liver of patients with tuberculosis from damage.

The present invention is to reduce the hepatotoxicity of antituberculosis drugs and increase the effectiveness of treatment of pulmonary tuberculosis in the early stages, while not increasing the cost of treatment.

The proposed method of treatment of pulmonary tuberculosis, which consists in conducting anti-TB therapy and additional application in the early stages “amber-antitox” in a dose of 0.5 g 3 times a day for months, can improve the effectiveness of treatment, to reduce the hepatotoxicity of antituberculosis drugs and economically profitable.

Earlier in tuberculosis “amber-antitox” was not applied. We have found that the “amber-antitox”as a representative of a new class of drugs - of energy regulators the definition of currency, it also has hepatoprotective activity. The cost of treatment by a preparation “amber-antitox” about 100 rubles, which is 2-10 times lower than the cost of other hepatoprotectors (Essentiale, Heptral).

The method is as follows.

After 1 week of stay of the patient in the hospital, upon completion of the survey was administered treatment “amber-antitox” 1 tablet 3 times a day for 1 month, against the background of anti-TB therapy.

Mainly used 4-component treatment regimen: intermittently (2 times per week) intravenous drip isoniazid and rifampicin, intramuscular injection (1 hour before dropper) streptomycin (kanamycin) and pyrazinamide inside sredneterapevticheskih dosages (2 hours before drip).

Intravenous drip of anti-TB drugs (isoniazid, rifampicin) is carried out in specially equipped treatment room. Cooked the medicinal mixture in the amount of 150-180 ml injected into a vein at 60 drops per minute. Isoniazid before infusion at a dose of 12-14 mg/kg of the ampoule is transferred into a sterile 0.9% sodium chloride solution, prepared in bidistilled water no later than 24 hours ago. To the vial attached disposable sterile system for intravenous infusion, vial for replay on a tripod. 3-4 capsules of rifampicin (450-600 mg) was injected into the vial with a sterile solution of 5% glucose in a volume of 150-200 ml Vial fix on the same tripod. Immediately after infusion isoniazid carry out intravenous drip rifampicin.

Example: Patient T., aged 45, is the driver. Bothered by the occasional cough with separation of minor amounts of sputum slimy character, General weakness, fatigue, excessive sweating at night. Pathological changes in the lungs revealed with the passage of fluoro. The patient is sent for further examination to the district dispensary, which was placed DZ: Infiltrative TB/d in the right lung in the phase of decay, contamination, Bq-. Within 2 weeks was spent on anti-TB treatment with isoniazid (0.6 g), streptomycin 1 g/m daily.

In a therapeutic clinic NIIT received 24.09.02, Complaints of the patient still. The General condition is satisfactory. The dullness of percussion sound over the top half of the right lung. The vesicular breathing, wheezing is not heard. Heart sounds are clear, rhythmic. The heart rate of 68 beats per 1 minute. HELL 120/80 mmHg ECG sinus rhythm 68 in 1 minute. Violation of intraventricular conduction. The voltage of the right ventricle. Indicators of lung ventilation function is normal.

Tongue moist, coated with white bloom. The belly rules enoi form, symmetric involved in breathing, mild, sensitive to palpation in the right upper quadrant. The liver stands out from the edge of a costal arch on 4 see an Ultrasound of the abdomen - liver stands out from the edge of a costal arch on 4 see the edge of the liver acute, echostructure not sealed. The gallbladder is a pear-shaped, the walls are sealed, no stones.

Clinical tests within variants of the rules except for the following parameters: in General, the analysis of blood - EMAS - 27 mm/h, in the General analysis of urine protein 0.25 g/l, in the biochemical analysis of blood fibrinogen - 3.75 g/l (upper limit of normal - 3.5 g/l), ACT - 45 (rule 38). Exceeding the specified parameters (ACT, fibrinogen), and increased liver palpation and ultrasound indicate the presence of hepatotoxic effect of anti-TB therapy in the clinic before admission to the clinic.

Mycobacterium tuberculosis was detected by culture - growth of 50 colonies, sensitivity to drugs saved. Bronchoscopy bilateral diffuse catarrhal endobronchitis 1-St degree.

When ray study of the right upper lobe (mainly in cortical sections C1, 2 and pricesonline), and C6 are determined by multiple focal shadows of different sizes, mostly average of intensive the STI, tend to merge, areas of decay. Left pockets of dropout in the root zone, reed segments.

Clinical diagnosis of Infiltrative tuberculosis of the upper lobe of the right lung in the phase of decay, contamination, Bq+.

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 1 hour intravenous infusion of 8 ml of 10% solution of polymer dissolved in 150 ml of physiological solution in combination with 450 mg rifampicin 200 ml of 5% glucose solution. One week from start of infusion appointment “amber-antitox” 1 tablet 3 times a day for months. Tolerability of the treatment was satisfactory.

During chemotherapy and treatment “amber-antitox” intoxication symptoms stopped after 3 weeks. Positive x-ray dynamics in the form of partial resorption focal shadows, the elimination of destructive changes recorded in a month from admission. Abacillation sputum after 2 weeks. The patient was transferred to outpatient mode.

Normalization of the ESR, ACT, fibrinogen, General urine analysis noted after 1 month. In the subsequent case of repeated laboratory tests indicators of liver function is within normal limits. ECG at discharge marked decrease in the load on the right depict rdie.

After 6 months the patient was transferred under the supervision of a district TB coordinator at the place of residence. The course of treatment was 52 infusions. All patient received isoniazid to 41.6 g, rifampicin and 23.4 g, streptomycin 52 g, pyrazinamide 78

Diagnosis at discharge: Infiltrative tuberculosis of the upper lobe of the right lung in the phase of resorption and seals, Bq-.

Thus, the use of “amber-antitox in combination with anti-TB therapy contributed to a favourable clinical course of tuberculosis, to relieve the symptoms of intoxication, normalization of well-being, resorption of focal inflammatory changes. Significant improvement: elimination of the destruction and termination of the bacteria in the early stages. The treatment resulted in normalization of activity of aminotransferases (ACT), fibrinogen. Long-term (within 6 months) massive chemotherapy took place on the background of normal liver samples. No clinical symptoms of poor tolerability, drug complications. Reducing the hepatotoxicity of antituberculosis drugs was one of the reasons for successful treatment. Also important is the low cost of treatment by a preparation “amber-antitox”.

In this way treated 19 patients with tuberculosis, which was the 1st (main) group. 2 (control) group consisted of 37 patients treated with the only anti-TB therapy. 1st and 2nd group matched by sex, age, nature of tuberculosis.

In most cases (72.2% of patients) in the lungs was common, was accompanied by the collapse (98.2% of patients) and patients (87.3% of people). Clinical forms of tuberculosis population was homogeneous, in the vast majority of cases (82,1%) were diagnosed infiltrative process.

The effectiveness of treatment of patients in both groups were evaluated according to standard criteria: period of liquidation of the effects of intoxication, the frequency of bacteriological conversion, as well as the degree of reparation pathological changes on the chest x-ray. The comparison of these indicators revealed some of their advantage in patients of the 1st group. Favorable action “amber-antitox” manifested a tendency to more rapid elimination of symptoms of General intoxication. So, persistent normalization of temperature, stopping night sweats, significant improvement in health observed already after 3 weeks in to 36.8% (7) patients of the 1st and only to 21.6% (8) patients of the 2nd group (t=1,19).

In persons 1-St group compared to the 2nd marked increase in the frequency of bacteriological conversion in the earlier period. So, after 1.5 months of treatment, immediately upon completion of the reception of “the amber-antitox”, Mycobacterium no longer be detected in mA is under the sputum and in crops patients-MBT + 1-th group significantly more often (in 11 of 18 (61.1 per cent)), than in patients (10 of 30 (33.3%)of them) of the control group (p<0.03 in, t=1,99). The frequency of bacteriological conversion in patients of the 1st, 2nd groups are presented in table 1.

Table 1.
 1st group 2nd group t1-2
 abs.%abs.% 
 12 
The number of smear-positive at entry1894,73081,11,63
Of these patients stopped after 1.5 months of treatment1161,11033,31,99

Dynamics of changes on the chest x-ray was also more favorable in patients of the 1st group. The closing of decay cavities up to 3 months of treatment was observed in 10 of 18 (55.5%) patients with destructive changes in the 1st and in 9 of 36 (25%) patients of the 2nd group (p<0,01, t=to 2.06). The frequency of closure of decay cavities in patients of the 1st and 2nd groups are presented in table 2.

Table 2.
 1st group 2nd group t1-2
 abs.%abs.% 
 12 
The number of patients with cavernous admission1894,73697,30,43
Of these cavities collapse closed up to 3 months treatment1055,5925to 2.06

The positive dynamics of changes in the ECG were observed more frequently in patients of the main group (9 out of 19 (47,4%)) compared with controls (8 of 37 (21.6 per cent)), (p<0.03 in, t=1,96).

Portability “amber-antitox” in all cases was good.

About hepatotoxicity held anti-TB chemotherapy was assessed by clinical symptoms and the results of biochemical studies of the liver in the dynamics (before treatment, after 3 months, before discharge).

Expressed signs of side effects of chemotherapy, which was accompanied by clinical symptoms of poor tolerability and made to interrupt or change the mode of therapy, observed only in 4 patients. Similar cases have occurred which with the same frequency in both groups.

Dynamics ALT, ACT in patients studied are presented in table 3.

Table 3.

Dynamics ALT, ACT in the patients of the 1st and 2nd groups
IndexBefore treatment “amber-antitox”After treatment “amber-antitox”  
 1 gr.2 gr.1 gr.2 gr.t3-4t2-4
 1234  
ALT30,7+5,939,4+8,526,7+3,345,9+7,92,230,56
ACT34,1+3,838+4,335,7+2,550,6+7,6to 1.86the 1.44

Patients of the main group values ALT ACT before and after a course of drug treatment “amber-antitox” did not change and were within variants of the norm. The use of the “amber-antitox” prevented the growth of activity aminotrasferase (ALT, ACT)which is registered in the 2nd group.

In contrast to the main group ALT ACT patients of the control group exceeded the upper limit of normal. Obvious is the tendency to increase the activity ACT. Occurring changes were not accompanied by severe clinical symptoms, only some of the patients complained of nausea in the days of treatment. Improved activity of aminotransferases was interpreted as a reflection of the negative impact of anti-TB therapy on liver function.

The dynamics of laboratory parameters before treatment and at discharge of patients from hospital (table 4).

Table 4.
IndexBefore treatmentAt discharge   
 1 gr.2 gr.1 gr.2 gr.t1-3t2-4t3-4
 1234   
ALT30,7±5,939,4±8,529,3±3,226,2±2,640,211,480,75
ACT34,1±3,838±4,334,4±2,138,3±5,00,070,050,72
Alkaline phosphatase170,6±13,6183,9±8,5156,2±9,9 165,5±7,40,871,630,77
GGT35,8±7,837,2±5,132,6±5,130,1±3,50,341,150,4
Thymol2,7±0,62,66±0,41,5±0,32,73±0,42,090,122,32
General. Protein71,2±1,2of 74.3±1,577,4±1,572,1±13,171,242,94
γ globulin15,3±1,619±0,515,5±0,918,3±0,90,110,682,14
Protram. Ind.93±1,6for 96.1±1a 94.6±2,2to 90.3±1,80,592,81,52
Fibrinogen2934±to 216.23029±177,52000±74,52690±158,34.09 to1,423,94
General. bilirubin10,5±19,3±0,76,7±0,58,2±0,5of 3.460,592,23

As follows from the table, the dynamics of indicators of the functional status of the liver in patients of the control group was insignificant.

The only exception was a significant reduction of retrovintage index. There was a trend to total protein content decreased (t=1,24); γ-globulin, reflecting the acute-phase inflammatory changes at discharge remained at the high level. Values for these parameters were within normal limits, but the shifts are probably a manifestation of the hepatotoxic effect of TB treatment.

In the basic group natural and statistically significant was the improvement of some indicators (thymol turbidity tests, total protein, fibrinogen, total bilirubin).

Comparison of indicators at discharge patients and control group indicates a highly reliable distinction of the following indicators: thymol turbidity tests, total protein, γ-globulin, fibrinogen, total bilirubin.

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 the treatment.

This method of treatment is the controlled treatment reduces drug load on the body.

The use of “amber-antitox reduces the hepatotoxicity of antituberculosis therapy, with cost-effective.

The use of “amber-antitox” showed no negative side effects on the human body, marked the favorable effects of the drug on the indicators of the functional status of the liver.

This method of treatment can be used both in hospital and outpatient practice (in the center), because it does not require large financial expenditures.

LITERATURE

1. Karachunskii etc. //Probl. the tubes. - 2002. - N7. - P.6-8.

2. Kutikova O.Y, etc. //Probl. the tubes. - 2002. - N4. - P.32-36.

3. Mukhtarov DZ //Probl. the tubes. - 2000. - N6. P.47 - 48.

4. Polunin IE //Clinical medicine. - 2002. - N2. P.47 - 50.

5. Minushkin on. //Clinical medicine. - 2001. - N12. - Ñ.38-41.

6. Koryakin V.A., Sokolova G.B., Sea AV, etc. //Ter. archive. - 1987. - N7. - P.75-77.

7. Ivashkin V.T. //Proceedings of Symposium 12 April 1997. - P.10.

The method of treatment of pulmonary tuberculosis patients by TB treatment, characterized in that it further in the early stages use “amber-antitox” in a dose of 0.5 g 3 times a day for months.



 

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FIELD: medicine, phthisiology.

SUBSTANCE: in early period the preparation "Yantar-antitoks" is used in the dose 0.5 g, 3 times per a day for one month in addition to the conventional antituberculosis therapy. Invention promotes to elimination of symptoms associated with the total intoxication, resorption of focus-infiltration changes, elimination of destructions and ceasing secretion of microorganisms for shorter periods. Invention can be used in treatment of pulmonary tuberculosis.

EFFECT: improved method for treatment.

4 tbl, 1 ex

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