Agent for treatment of conjunctiva inflammatory disease, bacterial damage of retina capsule

FIELD: medicine, ophthalmology, pharmacology, pharmacy.

SUBSTANCE: invention proposes a new agent for applying in therapy of inflammatory diseases of eye anterior site, namely, the silver-containing preparation "Argogel" "Argogel" represents argovite dispersion in polyethylene oxide gel. The preparation shows an antibacterial and virucidal effect and gel base shows additional keratoplastic effect. Invention can be used in therapy of conjunctivitis and retina suppurative ulcers.

EFFECT: valuable medicinal properties of agent.

4 ex

 

The invention relates to medicine and can be used for the treatment of conjunctivitis, purulent corneal ulcers.

Ulcerative lesions of the cornea are the most serious eye diseases that lead to significant vision impairment.

The problem of effective treatment of severe infectious lesions of the cornea is important not only because of the high frequency of this pathology, but also due to difficulties in treatment. Despite the wide range of pharmacological agents [1], increasingly there has been an increasing drug resistance of bacterial pathogens to antibiotics. Often pathogenic properties are conditionally pathogenic or opportunistic microorganisms. The results of the research conducted in the Department of infectious and allergic diseases of the eye IRI GB of them. Helmholtz, allow to identify the most common pathogens of bacterial corneal ulcers (>80%): Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus spp., S. pneumoniae, Pseudomonas aeruginosa, and rare Escherichia coli, Neisseria gonorrhoeae, Moraxella.

Epidemiology of infectious lesions of the eye undergoing major changes in recent years. According to our results and the data of researchers in the United States there has been a shift towards increasing of the proportion of gram-negative pathogens (the ratio of gram-positive and gram-negative in the of spadicea for 5 years has changed with 81,8% to 51.4% [2]).

Difficulties in the treatment of bacterial infections associated with two problems. The first is the increasing resistance of pathogens. So, to commonly used gentamicin number of resistant strains reaches 63.3% [3]. Second - growth more than twice the specific gravity of gram-negative pathogens and the etiology of pathogens (in 38% of cases there is a combination of bacteria, chlamydia, viruses, fungi and protozoa [4]).

Currently, for the treatment of infectious ulcers of the cornea widely used antibiotics quinolone series (fluoroquinolones): ofloxacin, ciprofloxacin, norfloxacin and lomefloxacin [5] (prototype).

The main drawback of these drugs is high cost, low bioavailability and a large number of toxic and allergic reactions to drugs produced near Indian firms. It was necessary to find an effective remedy, the most accessible, with minimal side effects are not inferior to the antimicrobial action similar drugs.

For the period 1999-2002 in the Department of "eye Microsurgery" treated 36 patients with purulent corneal ulcer. In 28.9% diseases of the cornea were due to a primary bacterial infection as the result of traumatic injury of the cornea, burns, surgical interventions, and 30.2% as a secondary affiliate of infection in long-term is rotokawa herpetic keratitis, dystrophy of the cornea, dry eye syndrome, but especially when the irrational use of corticosteroids, antiviral agents, antibiotics, anesthetics. Bacterial infection can cause the most aggressive process fulminant bacterial ulcers with subsequent development of endophthalmitis and perforation of the cornea. To optimize antibiotic therapy we have conducted research on the application in this group of patients the drug "Argovit and Argogel".

"Argovit" is a complex of silver with low-molecular medical polyvinylpyrrolidone [6], "Argogel" represents the variance of the argovit in hydrophilic matrix - gel-polyethylene oxide (PEO) [7]. Gel PEO [8] - dimensional cross-linked gel, used in medicine as the basis for preparing ointments, liniments and other soft dosage forms [9].

We used argovit in the form of 1% solution or argogel for local instillation and toleromune ulcer surface in monotherapy in 10 patients and combination therapy with antibacterial drugs other groups of 26 patients (perkenalan).

Revealed high efficacy and good tolerability of the drug in local installations up to 5-6 times the first 7-10 days with a subsequent decrease to 3-4 times a day until clinical cleansing of the ulcer surface and the first signs of epithelialization. Clinical effect cleansing of ulcers and the emergence of peripheral epithelization was evident in both groups, on average, 4-5 day use and significantly reduce the average length of hospital stay up to 13.8 days, whereas the commonly used techniques he is 20.6 days.

Example 1. Patient K., 38 years. The diagnosis of purulent corneal ulcer in the outcome of the injury wire. Were outpatients within 7 days; local instillation of levomycetin 5 R./A., tetracycline ointment 3 times/d, but without clinical effect. When entering the office when biomicroscopy found: on the cornea, in the optical zone is extensive infiltration with epithelial defect in the center, with indistinct edges, gray bloom, in the center covered with a purulent discharge. Into the tank. sowing detected pneumococcus, Staphylococcus aureus. Therapy: the instillation ciprofloxacin 5 R./D. and argogel 3 times/d For 4 days - a positive trend. The surface of the ulcers were cleansed, began epitelizatia from the edges. On the 5th day of the epithelial defect had been completed, the infiltration was reduced to 3 mm or two times. On the 9th day - complete epithelialization, formed leukoma of the cornea.

Example 2. Patient K., 58 years of age were treated in the Department of purulent-septic ICU about generalized sepsis, upon examination by an ophthalmologist diagnosed with ulcerative porage is their cornea in the outcome of xerosis. Started intensive therapy: mode instillation of 1% solution argovit every hour. 2 day was a significant positive trend: konyunktivalny cavity has been cleaned to the 4th day has expressed signs of epithelialization, full clinical recovery is the formation of lakomy to 8 days.

Accumulated positive experience of treatment of patients with purulent conjunctivitis.

Example 3. Patient R. 46 years old, was admitted with chronic conjunctivitis after unsuccessful treatment during the year. When tank. sowing the selected Pseudomonas aeruginosa. When scraping the conjunctiva enzyme-linked immunosorbent assay detected chlamydial infection. A course of etiotropic therapy in complex with ciprofloxacin and argogel 5-6 times a day for 14 days. Received positive clinical effect, confirmed by bacteriological and immunological tests.

Example 4. Patient is 46 years old, diagnosis: chronic conjunctivitis. Treatment with antibiotics for 2 months. did not lead to recovery. When tank. sowing discovered colonies of gram-negative bacteria. The complex therapy of a 1% solution of argovit 5 times a day. Received positive clinical effect, confirmed by bacteriological and immunological tests.

As can be seen from the examples, has the same efficacy as monotherapy, and p and combined use, that suggests the leading action argovit and argogel for edema inflammatory process in the cornea. The silver complex of unique biological properties, including the powerful antibacterial, antiviral effects, which makes the preparations of silver is very effective in the treatment of infected wounds, inseminated mixed infection. No toxic or allergic reactions from the eye tissues were noted. For effective treatment is of great importance not only drug choice, but the choice of the optimal dosage forms. This allowed us to evaluate a new form of drug release: argovit-argogel. The time of contact with the surface of the cornea is much larger than that of an aqueous solution, which allowed to reduce the number of installations up to 3 a day to achieve a clinical effect by 3-4 days of starting treatment. When the ulcer of the cornea of any etiology except antibiotics necessary funds metabolic reparative therapy. Gel-based argovit and provides additional keratoplasticheskie action.

It should be noted the low price of drugs with high therapeutic efficacy.

Sources of information

1. Michuk .F. // Therapeutic algorithms with infectious corneal ulcers. Journal of ophthalmology. - 2000. No. 3. - P.67-71.

2 Goldstein M.N., R.P. Kowalski, Y.J. Gordon // Emerging fluoroquinolone resistance in bacterial keratitis: a 5 year review. Ophtalmology. - 1999. vol.106. No. 7. - P.1313-1318.

3. Rabinowitz Y.S., Maumenee I.H., Lundergan M.K., et al. // Toxoid protects the cornea against tissue damage. Cornea - 1992. - v.11, No. 4. - P.302-308.

4. Angelov V.O., Krichevsky GI // Algorithm of diagnostic and laboratory tests in infectious diseases of the eye. Sat. Topical issues of inflammatory eye diseases. Ed. Uppick. M., 2001. P.39-41.

5. Michuk .F. // Therapy of infectious diseases of the eye. /Ophthalmological journal. - M., 1996. No. 4. S-199 (prototype).

6. Argovit. THE 9310-13-00008064-00. Reg. No. PTS 2-4.0/00495.

7. Argogel. THE 9158-001-23548172-02.

8. Gel PEO-1500 "Geco". VFS 42-3017-97.

9. The gel of polyethylene oxide-1500 "Geco" in medicine and cosmetics./ Sat. Tr. edited by Professor Blagica E.M. Ed. JSC "Novosibirsk chemical concentrates plant". Novosibirsk-Saratov-Pyatigorsk, 2001. P.150.

The use of argogel as a medicinal product in the treatment of inflammatory diseases of the anterior segment of the eye.



 

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