Method for treatment of acute nonspecific catarrhal conjunctivitis

FIELD: medicine, ophthalmology.

SUBSTANCE: method involves washing out the conjunctival sac with 0.03% sodium hypochlorite solution that is carried out 1 h before instillation of antibiotic. This washing out the conjunctival sac with sodium hypochlorite and antibiotic instillation is carried out 4 times per a day for 4-7 days. Invention promotes to reducing diseases time based on accelerated elimination of pathogens.

EFFECT: improved method for treatment.

2 cl, 2 tbl, 2 ex

 

The present invention relates to medicine, namely to ophthalmology, and can be used in clinical practice in the treatment of acute staphylococcal and streptococcal conjunctivitis.

According to epidemiological analysis of patients with inflammatory lesions of the eyes occupy the first place among applicants on outpatient reception (40,2%), accounting in the Russian Federation, about 16 million people per year. With inflammatory eye diseases linked up to 80% of cases of temporary disability, up to 50% of hospital admissions and up to 10-30% of blindness (Amoako, Vpilf, Idzumi, Mhgggoxe. New perspectives in the treatment of intraocular infections // West. Oftalmol. - 2000. No. 2. - P.20-22; Uppick. New in epidemiology and pharmacotherapy eye infections // Klin. oftalmol. - 2000.- T.1, No. 2. - P.48-51). A distinctive feature of the inflammatory diseases of the eye at the present stage is to increase the share of their protracted and chronic forms, resistant to standard antibiotic therapy because of polyvalent resistance of microorganisms to the antimicrobial (Engindeniz. Monomitsin with purulent diseases of the eye // Oftalmol. Journe. - 1975. No. 8. - C-596; Uppick. Eye infection // Rusmedcom. - 1999. - V.7, №1. - P.16-19).

Therefore, the treatment of purulent-inflammatory diseases of the eye at the present time remains and the relevant medical and social problem.

Know the use of antiseptics (oxidizing agents, acids, salts of heavy metals, the silver-containing medicines, dyes, etc.) externally for washing purulent discharge or in the form of eye drops in the treatment of acute nonspecific catarrhal conjunctivitis. In particular, ethacridine lactate (rivanol). Rivanol has antimicrobial effects, mainly in infections caused by coccal flora. The drug has low toxicity.

With copious purulent discharge designate rivanol for frequent washings in a dilution of 1:5000. Instillation of eye perform several times a day solution rivanol in the same breeding.

The disadvantage is that an aqueous solution of ravenala unstable, especially in the light (becomes brown), so you should only use freshly prepared solution, which limits its use (Medmaravis. Medicinal product. M: Medicine. - T2, 1988. - S).

The known method using 2% solution of boric acid. This solution manifests itself as antibacterial, antifungal and astringent. When backfilling or rinsing solution of boric acid coagulates the proteins of microbial cells.

The disadvantage of this method is that the drug is absorbed through the mucous membrane, penetrates into many organs and tissues and can accumulate. Displays the I slowly (with repeated introductions cumulates). Slightly irritating to granulating tissue. Sucking, especially the well penetrates the damaged skin and mucous membranes, cause systemic toxic effects. Furthermore, the method is not effective enough (Register of medicines. Encyclopedia of drugs. 2000. - S-155).

For the prototype we have adopted a method of treatment of acute bacterial conjunctivitis with profuse purulent discharge by washing the conjunctival cavity 2% aqueous solution of boric acid and instillation of 0.3% solution of gentamicin sulfate (Valery Morozov, Joe. Pharmacotherapy of eye diseases. M.: Medicine, 2001. - 56-57).

Disadvantages: the same as in the previous analogue and side effects from the use of antibiotic.

Objectives: increase the effectiveness of treatment of nonspecific catarrhal conjunctivitis, eliminate side effects.

The technical essence of the invention lies in the fact that in the complex of therapeutic measures, including the use of antiseptics and antibiotics in acute staphylococcal or streptococcal conjunctivitis 1 hour before instillation of antibiotic lavage is carried out conjunctival SAC 0.03% solution of sodium hypochlorite.

The reproducibility of the method there is no doubt, as used in known equipment and are available for medical PE the staff process. A solution of sodium hypochlorite at a concentration of 0.03% is produced by electrolysis of isotonic sodium chloride solution on the electrochemical apparatus of detoxification EDO-4 in the automatic mode.

Sodium hypochlorite is an oxidizing agent and is widely used in purulent surgery. Drugs, disinfectant, antiseptic, antimicrobial and detoxification. The resolution of the pharmacological Committee of the MOH of Russia from 09.07.92 (minutes No. 12) is allowed to use a solution of sodium hypochlorite in the dosage form at a concentration of 0.06% for intracavitary and external use. In the Case of drugs (encyclopedia of drugs. 2002. - S) says that in this concentration should avoid drug in the eye, and there are indications that the use of the drug in otorinolaringologii when backfilling of the nose and gargling should be diluted with water 1:1. We have conducted an experimental study on 100 healthy rabbits (200 eyes) to study the effects of instillation of different concentrations of sodium hypochlorite on the fabric of a healthy eye. According to the ophthalmologic examination, morphological and morphometric studies have shown that the effect of sodium hypochlorite on the eye of the rabbit as single or multiple at concentrations of 0.02 and 0.06% not causes is no change in intraocular pressure; concentration of 0.03% and 0.02% does not reduce the sensitivity of the cornea and does not cause clinical and morphological changes in the tissues of the conjunctiva and cornea (Ayiriminda, Auatralian, Sgul Rashid. The possibility of using sodium hypochlorite as antimicrobial agent in ophthalmic practice // Kuban nauchnoi. No. 3 (64), 2003. - S. 24-25).

The method is as follows.

First by washing the conjunctival SAC 0.03% solution of sodium hypochlorite, 1 hour instilliruut 1 drop of 0.5% solution of gentamicin sulfate. Washing with a solution of sodium hypochlorite and instillation of antibiotic exercise 4 times a day under ophthalmological control to the remission of the inflammatory process, mainly within 5-7 days.

We experimentally proven effective impact rinses conjunctival SAC 0.03% solution of sodium hypochlorite in the treatment of conjunctivitis 60 rabbits (120 eyes). The first series of experiment conducted with staphylococcal conjunctivitis, and the second streptococcal, 30 rabbits in each series.

Model to study the effect of sodium hypochlorite on the inflammatory process in the conjunctival SAC served as conjunctivitis, played by instillation in healthy eyes 2 drops of a one-day suspension culture of Staphylococcus aureus 209 P or culture Streptococcs pyogenes. Two days after infection, when developed conjunctivitis with purulent discharge, rabbits randomly in each series of experiment were divided into 2 groups of 15 animals (30 eyes) in each for comparison.

In the 1st group the complex of therapeutic measures include: first, wash the conjunctival SAC 0.03% solution of sodium hypochlorite, after 1 hour, the instillation of 0.5% solution of gentamicin sulfate 1 drop in both eyes. Washing with a solution of sodium hypochlorite and instillation of antibiotic did 4 times a day. In the 2nd group therapy: washing with a 2% solution of boric acid to 4 times a day in combination with instillation of 0.5% solution of gentamicin sulfate 1 drop 4 times a day.

When assessing therapeutic effect of sodium hypochlorite took into account the timing of the disappearance of purulent discharge and remission of the inflammatory response.

Table 1
The dynamics of the pathological process in groups of rabbits with the simulated conjunctivitis (days, M±m)
GroupThe number of eyesThe timing of the disappearance detachableTerms of remission of the inflammatory response
Staphylococcal
1 304,00±0,09*5,00±0,09*
2305,13±0,146,33±0,17
Strep
1304,67±0,12*of 5.92±0,13*
230of 6.71±0,198,21±0,21
Note: * - p<0,05 between groups.

After completion of experimental studies of the proposed method was tested on 20 patients with acute nonspecific catarrhal conjunctivitis, addressed in paragraph urgent eye care at eye microsurgery Department of City clinical hospital №3, Krasnodar.

Table 2
The duration of treatment non-specific purulent conjunctivitis (days, M±m)
The evaluated criteriagroup 1 n=20, (26 eyes) 0,03% aq sodium hypochlorite and 0.5% aq gentamicingroup 2 n=20, (23 eyes) 2% aq boric acid +0.5% of R-R gentamicin
Age (years)40,9±2,344.1kHz±3,3
Ill to treatment in hospital2,50±0,122,15±0,16
The term purulent discharge2,71±0,074,75±0,20*
Treatment duration3,96±0,086,10±0,25*
Total disease duration6,46±0,168,25±, and 0.40*
Note: *- p<0,05 between groups.

The table shows that in all patients the time purulent discharge, treatment and the total duration of the disease were less than the method of treatment of the prototype.

Example 1: out-patient map No. 5681. Patient, 47 years addressed in paragraph urgent eye care with complaints of redness of the left eye, pain and purulent discharge, constant watering. Got sick 2 days ago urgently. First in the morning “itched”, then blushed to the eyes, in the evening there were purulent discharge, every other day asked for medical help. In the ophthalmic examination moderate injection of the conjunctiva of the left eye. Moderately expressed purulent discharge. Conjunctiva of the eyelids swollen with microhemorrhages in the follicles. The cornea is transparent. Front camera is average. Pupil 3 mm transparent Optical medium. The eyeground in norm. Given the complaints of the patient history and data ophthalmologic examination, the patient was diagnosed with Acute purulent, konyu krivit left eye. For the microbiological examination was taken scraping and purulent discharge from the conjunctival SAC. The patient was carried out washing the conjunctival SAC 0.03% solution of sodium hypochlorite and after an hour or installation of 0.5% solution of gentamicin. Washing and instillation was performed 4 times a day. On the third day from the beginning of treatment of purulent discharge disappeared. On fourth - signs of inflammatory reaction was not observed. Treatment abolished. After three days was obtained for microbiological analysis. The patient selected Streptococcus pyogenes is sensitive to chloramphenicol, gentamicin and cephalexin. Final diagnosis: Acute catarrhal streptococcal conjunctivitis of the left eye. The total duration of illness was 6 days, antibacterial treatment to 4 days.

Example 2: Outpatient map No. 26600. Patient A. 45 years addressed in paragraph urgent eye care with complaints of redness of the right eye, pain, purulent discharge, a feeling that something has got into eyes. Got sick 2 days ago urgently. Blushed right eye began to itch, and later appeared purulent discharge, every other day asked for medical help. In the ophthalmic examination moderately severe conjunctival injection right eye. Moderate purulent discharge OD. Conjunctiva eyelid edema without hemorrhages in the follicles. The cornea is prozracna. Front camera is average. Pupil 3 mm transparent Optical medium. The eyeground in norm. Given the complaints of the patient history and data ophthalmologic examination, the patient was diagnosed with Acute purulent conjunctivitis of the right eye. For the microbiological examination was taken scraping and purulent discharge from the conjunctival SAC. The patient was carried out washing the conjunctival SAC with a 2% solution of boric acid with subsequent instillation of 0.5% solution of gentamicin. Washing and instillation was performed 4 times a day. On the fifth day from the beginning of treatment of purulent discharge disappeared. On the sixth of inflammatory reaction were observed. Therapy was completed. On the tenth day of the obtained microbiological analysis. The patient selected Streptococcus pyogenes is sensitive to chloramphenicol, gentamicin, tetracycline and cephalexin. Final diagnosis: Acute catarrhal streptococcal conjunctivitis of the right eye. The total duration of illness was 7 days, antibiotic therapy 6 days.

When using the method allows to reduce time of treatment of acute nonspecific catarrhal conjunctivitis.

The method is recommended for wide use in medical practice.

1. A method of treating acute nonspecific catarrhal conjunctivitis, including the influence of the antibiotic, characterized in that, for 1 h before instillation of antibiotic lavage is carried out conjunctival SAC of 0.03%solution of sodium hypochlorite.

2. The method according to claim 1, characterized in that the irrigation of conjunctival SAC sodium hypochlorite and instillation of antibiotic is conducted 4 times a day for 4-7 days, and instillation of an antibiotic may be reduced according to the testimony.



 

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