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Method of treating chronic recurrent vulvovaginitis
IPC classes for russian patent Method of treating chronic recurrent vulvovaginitis (RU 2423978):
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Invention relates to a method for treatment of patient suffering with allergic disease. Method involves administration to patient the therapeutically effective dose of pharmaceutical composition comprising compound of the formula (I)

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dermato-venerology and gynecology, and can be applied for treatment of chronic recurrent candidal vulvovaginitis. For this purpose together with antifungal medications inside prescribed is antihistaminic medication erius in day dose 5 mg for 10 days. Then, monthly 5 days before menstruation and during 5 days after it. After that, in pills in day dose 5 mg inside for 6 months.

EFFECT: method insures adequacy and safety of therapy and makes it possible to reduce dosage of antifungal medications, quickly reduce disease symptoms and reduce of relapse frequency of recurrences.

3 ex

 

The invention relates to medicine, in particular to the gynecologist, and for the treatment of chronic recurrent chronic Candida vulvovaginitis.

There is a method of treatment of vulvovaginal candidiasis in pregnant women by adjuvant therapy, including basic combo antimycotic drug and intravaginal introduction proteoliticeski immobilized enzyme - kasimasi at a dose of 5 ml (300 PE) in the 1st, 5th and 10th days of treatment [RF patent № 2262948 from 12.04.2004, IPC7AC 38/43, OR 43/00, publ. 27.10.2005 St]. As a result, through the full rehabilitation of the vagina decreases the number of complications during pregnancy, childbirth, postpartum and early neonatal periods.

The disadvantage of this method is that it is recommended only for pregnant women. In addition, this method does not completely eliminate the fungal infection from the body and its application to chronic forms of the disease is not possible to achieve full cure and does not reduce the recurrence rate.

There is a method of treatment of vulvovaginal candidiasis, including medication antifungal therapy, electrophoresis, zinc, prodigiozana, ultraviolet irradiation region of the perineum, in the beginning spend bipolar electrophoresis solutions of sulphate of zinc and prodigiozana for 15-20 min, after which the wasp is estlat ultraviolet irradiation of the perineum, and with 5-6 days before the procedure of electrophoresis carried out deep laser therapy by introducing the light of the nozzle into the vagina until it stops in the cervix, the course of treatment consists of 10 treatments carried out daily [description of the invention to the patent of Russian Federation № 2155613 from 08.07.1997, IPC7A61N 1/30, A61N 5/067, AK 33/30, AK 35/74, publ. 10.09.2000]. As a result, increases antimycotic effect of the treatment, reducing the rate antifungal therapy, increases the immunological reactivity of the organism and achieved long-term remission.

The disadvantage of this method is the need for regular visits to health facilities and use of physiotherapy equipment. In addition, its disadvantage is its limited indications, because the success of it can be applied only for sexually active women.

In the most General sense is a method of treatment of chronic vulvovaginal candidiasis includes vaginal douching solutions of antifungal substances in 3-5 days morning produce irrigation with 3%solution of protargol followed by the introduction of crushed tablets nystatin sprayed onto the wall of the vagina and its arches, and in the evening irrigation with 5%sodium bicarbonate, followed by the introduction of sodium tetraborate in glycerol [RF patent № 2113852 from 01.09.1994, IPC 6AC 33/38, AK 33/00, AK 35/70, A61N 5/06, AV 17/42, publ. 27.06.1998]. As a result, the background stimulation of nonspecific resistance of the organism is provided as a local treatment of vulvovaginal candidiasis.

The disadvantage of this method is that in chronic forms of the disease local treatment is not always effective. In addition, this method allows to effectively treat acute exacerbation of chronic recurrent vulvovaginal candidiasis, but does not prevent the emergence of new relapses.

The task of the invention is the efficiency of the treatment method, ensure the adequacy and safety of therapy at lower dosages of antifungal drugs, the rapid reduction of symptoms and reduce the frequency of relapses.

To solve the problem and achieve the claimed technical effect in the treatment of chronic recurrent vulvovaginal candidiasis, including the oral use of antifungal drugs, together with anti-fungal prescribed drugs inside antihistamine drug Arius in a daily dose of 5 mg for 10 days, and then monthly for 5 days before menstruation and during 5 days after it, and then tablets in a daily dose of 5 mg orally for 6 months.

Thus, the claimed ability is b the treatment of chronic recurrent vulvovaginal candidiasis involves the use of antifungal drugs type Fluconazol and/or Itraconazole, assigned based on the severity of the disease (relapse and their frequency, persistent option currents and other), the anatomical localization of infection (vagina, vulva, skin, etc. and in accordance with the sensitivity of isolates of Candida, in addition prescribe antihistamines drug Arius mainly third generation, in a daily dose of 5 mg, orally, for 10 days, and then monthly for 5 days before menstruation and for 5 days thereafter, in tablets, in a daily dose of 5 mg orally for 6 months. As anihistamines drug use desloratadin (Arius) (registration number P # 014704/02 07.09.2004) in the course dose of 350 mg

Analyze the materiality of the features of the invention.

Candida albicans is a powerful allergen (Moraes PS, de Lima Goiaba S, Taketomi EA. Candida albicans allergen immunotherapy in recurrent vaginal candidiasis // J Investig Aliegol Clin Lmmunol. - 2000/ - Vol.5, No. 10. - P.305-309), and suggested that local hypersensitivity to these yeast may be a factor in the prolongation and the recurrence of the disease. Colonization of Candida albicans in the vagina and the vulva supports mycotic sensitization of the body, helps hyperproductive Ig E and increases the willingness to giperergicakie reactions to damaging antigen. Elevated levels of total Ig E in blood and the presence of foci of fungal infection supports persistent, chronic Kida the dose candidiasis.

For this reason, in addition to the recommended antifungal drugs type Fluconazol and/or Itraconazole recommended to administer antihistamines.

Antihistamines new generation are divided into inactive metabolites (prodrugs) and pharmacologically active metabolites.

Representatives of inactive metabolites - Bastin (kestin), acrivastine (semprex), loratadine (claritin, lomilan) are prodrugs, as the ingestion they become not only a pharmacologically active metabolites, but in the other metabolites, competing in the binding of H1-receptors. Therefore, they are non-competitive contact with H1receptors and in violation of the metabolism of these tools, especially when used concomitantly with other drugs, such as macrolides and antifungal agents, can accumulate and have undesirable side effects, in particular, to be present.

Of particular importance are pharmacologically active metabolites cetirizine, Fexofenadine, desloratadine and levocetirizine. These drugs selectively associated with H1-receptors do not have competition for places on these receptors, their action does not depend on food intake or drugs, and therefore they are more effective, safe, predpochtitel the s. Among the products of a new generation of the most potent and selective antagonist of the N1receptor is desloratadin, as it has the greatest affinity for H1-rapeporn and longest half-life (27 hours). In controlled studies proved that the effect of the first dose of desloratadine in the morning lasts until the next morning. It acts quickly and extended, its effect does not depend on food intake or drugs, the absorbance decreases with the consumption of fatty food, taking antacids, the high content of salt in the diet. In addition to antihistaminic actions desloratadin also has anti-allergic and anti-inflammatory effects. Desloratadine inhibits the effects of many mediators involved in the development of allergic inflammation, including cytokines (TNFand, IL-3, IL-4, IL-8), chemokines, and intercellular adhesion molecules, including P-selectin and ICAM-1.

Thus, the essence of the proposed invention is that to the basic therapy of chronic recurrent vulvovaginal candidiasis, including antimycotic drugs, joins an antihistamine, desloratadine (Arius) (registration number P # 014704/02 07.09.2004). Reception of desloratadine promotes rapid relief the main symptom is the disease: itching, burning sensation, swelling of the external genitalia. All patients with the use of desloratadine led to considerable improvement and to reduce the frequency of relapses during the year of follow up. In the first days of use of desloratadine in comparison with the control group received the recommended antimycotic therapy (40 observed patients received traditional treatment)were found to reduce itching, burning, swelling of the vulva, improve quality of life.

The efficiency of this method was confirmed in 43 volunteers (women of reproductive age) in the age groups from 18 to 45 years, suffering from chronic recurrent vulvovaginal candidiasis from 1 year to 7 years.

Example 1. Patient L., 32 years old, married, profession credit inspector came for a consultation with complaints cheesy discharge from the genital organs, expressed itching, burning, swelling of the vulva, frequent painful urination, irritability, poor sleep, decreased attention. Ill Candida vulvovaginitis about seven years. Onset links with the operational delivery by caesarean section. Exacerbation of the disease 10-11 times a year, often treated with oral antimycotics and local action. Index questionnaire William G. Crook [see adaskevich VP diagnostic industries, the ski indices in dermatology. - Moscow: a Medical book. - 2004, 165 S.] for patients with candidiasis 16 points.

The General condition is satisfactory. Systolic blood pressure of 110 mm Hg, diastolic 60 mm Hg, heart rate of 78 beats per minute, satisfactory filling and tension.

Objective examination: redness, swelling, white bloom and maceration of the labia, the vaginal mucosa, phenomena cervicitis, rich cheesy discharge.

Microscopic examination of smears detected yeast. Microbiological study was identified Candida albicans at a concentration of 109COE/ml

Diagnosis: Chronic recurrent vulvovaginal candidiasis in the acute stage.

In General, the analysis of blood: b 128 g/l, er. of 4.2×1012/l; L 8,2-109/l 1%, P.60%, A%, limp. 30%, mon. 8%; ESR 10 mm/h in Serum IgE 110 (ke/l). Patients received comprehensive treatment of the proposed method with the purpose of desloratadine (Arius) in a daily dose of 5 mg, orally, for 10 days. At the end of treatment achieved clinical and microbiological cure. Over the next 6 months follow up, the patient courses were conducted preventive anti-relapse therapy Ericom tablets, orally, in a daily dose of 5 mg, on a monthly basis for 5 days before menstruation and for 5 days thereafter. Recurrence within 12 months was not observed.

<> Example 2. Sick So 40 years old, married, by profession a teacher in the school. He complained of frequent painful urination, itching and burning in the genital area, dragging pain in the perineum, the impossibility of intimate relationships. Ill vulvovaginal candidiasis more than 5 years. Onset connects with antibiotics. Exacerbation of the disease last year, almost every month, mainly before or after menstruation. Repeatedly treated with oral antimycotics and local action. Index questionnaire William G. Crook for patients with candidiasis 18 points.

The General condition is satisfactory. Systolic blood pressure 120 mm Hg, diastolic 70 mm Hg heart rate of 74 beats per minute, satisfactory filling and tension.

Objective examination: redness and swelling of the openings of the urethra, labia minora, vulva and the vaginal mucosa, rich cheesy discharge.

Microscopic examination of smears detected yeast. Microbiological study was identified Candida albicans at a concentration of 1010COE/ml

Diagnosis: Chronic recurrent vulvovaginal candidiasis in the acute stage.

Complete blood count: b 130 g/l, er. 4,0-1012/l; L 7,1 109/l, 4%, P.65%, A%, limp. 22%, mon. 8%, erythrocyte sedimentation rate of 12 mm/h in Serum IgE 80 (ke/l).

Patients received a comprehensive treatment of marinatin techniques with simultaneous prescription of desloratadine (Arius) in a daily dose of 5 mg, inside, within 10 days. At the end of treatment achieved clinical and microbiological cure.

Over the next six months follow up, the patient courses were conducted preventive anti-relapse therapy Ericom tablets, orally, in a daily dose of 5 mg, on a monthly basis for 5 days before menstruation and for 5 days thereafter. Clinical observation of the patient over 1 year acknowledged the absence of acute vulvovaginal candidiasis.

Example 3. Patient W., 22 years old, single, student. He complained of cheesy discharge, itching and burning in the genital area, dragging pain in the abdomen, depressed, anxious mood because of illness, the impossibility of sexual life and sports. Ill Candida vulvovaginitis about 2 years. Disease associates with the beginning of sexual life. Exacerbation of the disease notes 6-7 times a year. Repeatedly treated with oral antimycotics and local action. Index questionnaire William G. Crook for patients with candidiasis 15 points.

The General condition is satisfactory. Systolic blood pressure 120 mm Hg, diastolic 60 mm Hg heart rate of 70 beats per minute, satisfactory filling.

Objective examination: redness and swelling of the mucous membrane of the vagina, cervix, labia, whitish plaque and the matzah is the situation of the vaginal mucosa, cervical, cheesy discharge.

Microscopic examination of smears detected yeast. Microbiological study was identified Candida albicans at a concentration of 1010COE/ml

Diagnosis: Chronic recurrent vulvovaginal candidiasis in the acute stage.

Complete blood count: b 142 g/l, er. 4,4-1012/l; L 6,0-109/l, 2%, P.66%, A%, limp. 24%, mon. - 6%, erythrocyte sedimentation rate of 4 mm/h in Serum IgE 60 (ke/l).

Patients received comprehensive treatment according to standard techniques with simultaneous appointment of ERISA in a daily dose of 5 mg, orally, for 10 days. At the end of treatment achieved clinical and microbiological cure. Over the next 6 months follow up, the patient courses were conducted preventive counter-recurrent therapy Ericom tablets, orally, in a daily dose of 5 mg, on a monthly basis for 5 days before menstruation and for 5 days thereafter. Recurrence was not observed for 1 year.

Thus, the use of the proposed method has been able to reduce the dosage of antifungal drugs has improved the treatment efficiency rapidly decreased symptoms, a positive effect on psycho-emotional status of patients with chronic recurrent vulvovaginal candidiasis. Conducted preventive against the recurrent therapy Ericom extended periods of remission, improved the quality of life for this group of patients.

A method for the treatment of chronic recurrent vulvovaginal candidiasis, including the oral use of antifungal agents, characterized in that together with anti-fungal prescribed drugs inside antihistamine drug Arius in a daily dose of 5 mg for 10 days, and then monthly for 5 days before menstruation and during 5 days after it, and then tablets in a daily dose of 5 mg orally for 6 months.

 
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