Method of treating pulmonary tuberculosis

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to phthisiology, and can be used in treating pulmonary tuberculosis accompanied by tuberculosis intoxication. To this effect, administering anti-tuberculosis preparations is combined with the additional intravenous drop-by-drop administration of Reamberin, Heptral and antitoxic polyvalent antigangrenous serum (AGS) preceded by the administration of heparin 50 units/kg; Reamberin is administered in an amount of 400 ml on the first and second day for 2 hours; Heptral is introduced in an amount of 400 ml from the first to the fifth day; AGS is administered on the third day in an amount of 30 thousand International Units, on the fourth day in an amount of 60 thousand International Units, in case of a destructive process - in an amount of 60 thousand International Units on the fifth day; AGS is administered in normal saline NaCl 400 ml, and the first 1 ml of the solution is administered for 5 minutes, the rest amount - for 1.5-2 hours.

EFFECT: method enables increasing the clinical effectiveness of pulmonary tuberculosis as soon as possible by binding and neutralising microbial exo- and endotoxins by serum antibodies with no side effects and reduced financial expenses.

4 tbl, 3 ex

 

The invention relates to medicine, namely to Phthisiology.

Despite the use of the most effective antibiotics and modern technology, the mortality rate from TB is still high. The growth of genetically mutated bacteria makes us look for a safe strategy for patients fight bacteria. Known method of treatment of pulmonary tuberculosis, representing the use of combinations of antibiotics with Pentaglobin.

Pentaglobin - human immunoglobulin, intravenous, neutralizes endotoxin microbes in bacterial infections. The dosage of 5 ml/kg of body weight, the drug is administered within 3 days.

The disadvantages of the prototype include the fact that it is unstable to the action of bacterial proteases; it cannot be entered when the kidney function, described cases of aseptic meningitis after the introduction of Pentaglobin.

The aim of the invention is to improve the efficiency of treatment of pulmonary tuberculosis.

The essence of the proposed method in the invention is as follows: patients with tuberculosis intoxication, regardless of the stage of infection, intravenous infusion, administered antitoxic, polyvalent, protivomigrenoznoe serum - PGS. Administration scheme: for 400 ml of isotonic NaCl injected antitoxic, polyvalent, protivomigrenoznoe serum - 1 dose (30 thousand. international units). The first 1.0 ml of the resulting solution is injected within 5 minutes as the sample in the reaction, the remaining volume for 1.5 to 2 h (manual approved beg. CH. Ctrl. The USSR Ministry of health, 1988).

The primary mechanism of action of anti-toxic polyvalent protivomigrenoznoe serum (ASG) is binding and neutralization of Exo - and endotoxins microbial antibodies contained in the serum.

Example 1 a specific embodiment of the method.

Ziyavudinov Mr. Murad, 1979, Republic of Dagestan, Makhachkala, PR. Kirova, 59/29. First went to a TB specialist 25.12.09 G. complaints: irritability, insomnia, sweating, long, over 1 month, low-grade fever. In the blood - moderate leukocytosis, lymphocytosis, ESR acceleration. In urine: leukocytes, traces of protein.

R-gram from 25.12.09 - infiltrative lesions of the upper lobe of the right lung. Within 420 days (25.12.09-06.01.12 G.) took anti-TB drugs: isoniazid 900 mg per day, in combination with rifampicin, 750 mg × 2 times a day, for 180 days. Capreomycin 1 g 1 times a day, for 120 days. Ftivazid 1 g × R. 2 a day, for 120 days. In R-gr. lungs No. 1879 from 17.06.10 g, on CT of the lungs from 06.01.10 - infiltrative lesions in the upper lobe of the right lung.

01.05.12 G., simultaneously introduced ME 60 thousand (2 doses) PGS. In R-gr. from 31.05.12, chest - ver�her lobe of the right lung calcified focal shadows. The structural roots. Pulmonary pattern is reinforced. Sinuses available. Heart without features. It is recommended to consult a TB. Removed from the register. Healthy.

Example No. 2.

Musaev Elmira, 1986 Dagestan, Makhachkala, Ave. Petra-I, house 53, 58 sq (leave to care for a child) 29.11.11 g., due to the severity of the condition, admitted to hospital with DS: Infiltrative Tbc lung in the phase of disintegration. Tuberculosis intoxication. NAM II art.

With 29.11.11 on 18.06.12 during the 215 days treated in hospital. Lung CT from 25.04.12, No. 6854 - in the upper lobes of the lungs and in the lower lobe of the left lung are defined by multiple large pockets, sometimes merging with the formation of infiltrates irregular and rounded shapes, some of which is located subpleural. In part infiltrates seen small cavity decay. Viewed microfocal infiltration in both lungs. Conclusion: CT-signs of hematogenous-disseminated tbc lungs. In R-gr. lungs No. 1836 dated 15.06.12 - left subpleural rounded education: 5×4.5 cm complaints of sleep disturbance, weakness, dry mouth, itchy skin.

15.07.12 G. entered, simultaneously, 2 doses of ASG. 16.07.12 - 2 doses of ASG, on the background of prior administration of heparin.

14.08.12 - tomogram No. 1886. The plot of the cavity is reduced in volume. The deformed contours, perifocal infiltration is difficult to trace, fibrous cord reduced. Consul�targeted by fisierelor. The dynamics is positive. His condition is satisfactory. Conclusion: surgical treatment abstain.

CT 16.05.13, No. to 12,254 in the upper lobe of the right lung, in the upper and lower lobes of the left lung areas are defined tâžistaâ deformation pulmonary stroma, seal the pulmonary interstitium, traction bronchiectasis, multiple dense foci. Amid these changes in the upper lobe, there is a round dense formation with clear contours, with a diameter of 18 mm. the Lumen of a major bronchus is not deformed. Mediastinal lymph nodes are not enlarged. Vascular structures in the mediastinum without features, fluid in the pleural cavity is not revealed. Conclusion: CT-signs of fibrous-focal changes of the lungs.

Example # 3

Musayev Shamil, 1982 Dagestan, Makhachkala, Ave. Petra-I, house of 53 sq 58, the driver of a private enterprise. Spouse Musaeva E. Extremely irritable. From examination and treatment refused.

02.10.12 - entered 1 dose ASG intravenous drip: 03.10.12 G. D. 2 PGS. (the scheme).

CT - 29.10.12 G. comparing (05.09.12) + dynamics. Conclusion infiltrative pattern of spectrins at the level of 1st-2nd segments of the right lung in the phase of resorption.

21.02.13, R-gram of the chest is determined lungs without fresh lesions or infiltrative changes. Single calcined in the upper $ � left lung. Heart without features. 21.02.13 G. removed from the register.

The advantage of the proposed method is as follows:

1. the antibodies contained in the ASG, not broken down under the influence of bacterial proteases;

2. the lack of contraindications for insertion and complications when injected.

In our practice, all patients that were administered anti-toxic protivogangrenoznuyu polyvalent serum, in the next day it was noted positive dynamics: improved health, normal sleep, temperature. Improved indicators and peripheral venous blood (table 1, 2, 3, 4).

The proposed method of treatment of pulmonary tuberculosis allows you to:

1. To achieve positive results, in the shortest possible time, in the absence of side effects and any contraindications for the use of antitoxic serum. ASG.

2. To minimize the risk of developing drug-resistant strains of bacteria.

3. To reduce the time of treatment.

4. To solve the problem of social rehabilitation of the patient.

5. To reduce the financial cost of treatment.

Sources of information

1. Pentaglobin BIOTEST PHARMA Gmbh, Germany - prototype.

2. METHOD of TREATMENT of PNEUMONIA IN extremely premature infants ON mechanical VENTILATION, (RU) patent 2191031.

3. METHOD of TREATMENT of pulmonary TUBERCULOSIS (RU) patent 235745.

4. Pentaglobin (Pentaglobin®): instructions for use, contraindications and composition - Register of medicines - radar.

5. Serum protivomigrenoznae polyvalent equine purified concentrated liquid product form: solution for injection 30 thousand ME, ILA. 1 dose (1) complete with horse serum diluted 1:100, amp. 1 ml (1) Manufacturer: FSUE NPO "Microgen".

6. Serum protivomigrenoznae polyvalent equine purified concentrated liquid (Serum antigangrenosum polyvalentum purificatum concentratum equinum passiflorae): instructions for use, contraindications and composition - radar.

Table # 1
Scheme of the proposed method of treatment, depending on the severity of the process
The name of the drug, method of administration, within what time1st day
Dose
2nd day
Dose
3 days
Dose
4 days
Dose
5 days
Dose
1. Reamberin of 1.5 in/in drip for 2 hours400 ml400 ml
2. Heparin IV infusion, at a dose of 50 units/kg simultaneously, before the introduction of PACSHeparinHeparinHeparin
3. Antitoxic serum ASG/drip, within 2 hours1 D. - 30 thousand ME in 400 ml. of physics and R-RA60 thousand IU - 2D to 400.0 ml of a physical R-RA60 thousand ME to 400.0 ml of a physical R-RA (destructive process)
4. Heptral,/in400 mg400 mg400 mg400 mg400 mg

Table No. 2
A specific example
Name AgeDSThe treatment time. On an outpatient basis.Data R-research and lung CTDate of introduction and dose of the ATS-PGCData R-research and lung CT after modified�CSO treatment DS Raion
Ziyavudinov Mr. Murad, 1979 Dagestan, Makhachkala, PR. Kirova, 59 "a", apt 25Infiltrative tuberculosis of the upper lobe of the right lung25.12.09 06.01.12 A/b therapy within 420 daysCT of lungs from 06.01.10, the amount of CT pulmonary tbc upper lobe of the right lung R-gr. lungs No. 1879 from 17.06.10 G. and from 25.12.09 G.: infiltrative lesions of the upper lobe of the right lung01.05.12 G. D. 2 - ME 60 thousand simultaneousR-study of the gr. cells from 31.05.12,: in the upper lobe of the right lung calcified focal shadows. The structural roots. Pulmonary pattern is reinforced. Sinuses available. Heart without featuresHealthy.
Filmed subject

Table No. 3
A specific example
Name ageDS outpatientHospital number/daysData R-research and lung CTDate of introduction and dose of the ATS-PGCData R-research and lung CT after modification�rovannogo treatment DS of visioforge
Musaev Elmira, 1986 RD, M-Kala, Peter D.-I, 53 "in" / 58Infiltrative-tion tbc lung in a state of collapse. Name article II29.11.11 -18.06.12. G. Izberg. City hospital 215 K/h.CT scan-lung from 25.04.12 No. 6854, R-gr. from 15.06.12, No. 1836: in the upper lobes of the lungs and in n/lobe of the left lung, multiple large foci of irregular and rounded, a portion of which is located subpleural. In part infiltrates the cavity decay. Conclusion: signs of hematogenous-dessiminating tbc lungs. In R-gr. lungs from 15.06.12 G. left rounded education 5*4,5, subpleural15.07.12 G. 2 doses 2 doses 16.07.12 G.R-research from 14.08.12 G. linear tomogram No. 1886. The plot of the cavity is reduced in diameter, the deformed contours, perifocal infiltration is difficult to trace, fibrous cord reduced. CT No. to 12,254 from 16.05.13 G. + dynamics.

Table No. 4
A specific example of application of the SGS - in the treatment of tuberculosis, without prior AV-guarantees
Name age�t DSThe treatment timeData R-research and lung CTDate of introduction and dose of the ATS-PGCData R-research and lung CT after modified treatmentDS ftii-at
Musayev Shamil 1982 Dagestan, Makhachkala, Peter-1, 53, 58 sq
Refused therapy.
Spouse Musaeva Elmira
3 doses 02.10.12 G. 1 dose 03.10.12 G. 2 dosesR-research from 21.02.13, No. 30. Lungs without focal or infiltrative changes.
Single calcinate the upper lobe of the left lung. CT-29.10.12. however, the infectious spectrins at 1-2 segments of the right lung in the phase of resorption
Healthy

A method for the treatment of pulmonary tuberculosis in patients with tuberculosis intoxication, including the introduction of anti-TB drugs, characterized in that it further intravenously administered Reamberin, Heptral and antitoxic protivogangrenoznuyu polyvalent serum (ASG) with the provisional administration of 50 u/kg of heparin, Reamberin injected with 400 ml on the 1st and 2nd day for 2 hours; Heptral �about 400 mg from 1st to 5th day; PGS on day 3 the 30 thousand IU, on the 4th day 60 thousand IU, and in the case of a destructive process - 60 thousand IU for 5 days, and the calibration gas is introduced 400 ml of isotonic NaCl solution and the first 1 ml of the solution was injected for 5 minutes, the remaining volume within 1,5-2 hours.



 

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