RU1811848C - Method for treating patients suffering from severe shigellosis - Google Patents

Abstract

The invention relates to medicine and relates to the pharmacotherapy of infectious diseases. The purpose of the invention is to reduce the duration of toxicosis and the duration of treatment. Patients are prescribed antibacterial therapy in accordance with the sensitivity of Shigella to antimicrobial agents, colloidal solutions (hemodez, reopoliglyukin, polydez), crystalloids (Trisol, Acesol, Chlosol, Quartasol) in an amount corresponding to the degree intoxications and indicators of hemodynamics, vitamins, glucocorticoids (prednisone, hydrocortisone) in mid-therapeutic doses. Additionally, splenin is prescribed at 4-6 ml per day intramuscularly and acetylcysteine intramuscularly in the form of a 10% solution 2-3 times a day or intravenously in the form of a 1-3% solution in a daily dosage of 50-80 mg / kg body weight and inside - enterodesis in the form of a 3-5% solution in an amount of 5 g 3 times a day. At the same time, the effectiveness of pharmacotherapy increases, the treatment time is reduced, which makes it advisable to use the proposed method in a hospital setting. 2 s.p., crystals, 1 tab. with

Description

The invention relates to the field of medicine and relates to methods for treating infectious diseases. An object of the present invention is to reduce the duration of toxicosis and the treatment time for patients with severe shigellosis. This goal is achieved by the fact that when treating patients with severe shigellosis with antibacterial drugs, colloidal and crystalloid solutions, vitamins and glucocorticosteroids, splenin is additionally prescribed 4-6 ml per day intramuscularly, acetylstein at a dose of 50-80 mg / kg body weight intramuscularly or intravenously and 5 g enterodesis 3 times a day. .

The development of the proposed method for the treatment of severe, forms of shigellosis is based on the first detected and clinically proven property of these drugs to normalize metabolism, increase the antitoxic function of the liver, and reduce the severity and duration of infectious endointoxication. The achievement of the optimal therapeutic effect is due to the mutual potentiation of the mechanisms of the therapeutic effect of splenin, acetylcysteine and enterodesis.

The method is carried out as follows.

When a diagnosis of severe shigellosis is established, antibiotic therapy is prescribed for the patient in accordance with the sensitivity of shigella to antimicrobial

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colloidal solutions (homodesis, reopoliglyukin, polydez), crystalloids (trisol, acesol, chlorosol, quartasol) in the amount corresponding to the degree of intoxication and hemodynamic indicators, vitamins, glucocorticoid (prednisone, hydrocortisone) in the middle - rapeutic doses. In addition, splenin is prescribed at 4-6 ml per day intramuscularly, acetylcysteine intramuscularly in the form of a 10% solution 2-3 times a day or intravenously in the form of a 1-3% solution in a daily dosage of 50-80 mg / kg body weight and inside - enterodesis in an amount 5 g 3 times a day.

When developing the proposed method of treatment, 82 patients with a severe form of Shigellosis Flexner 1 B (colitis variant), having a common source of infection, were examined. Patients were randomly divided into 2 groups, which turned out to be comparable in severity of individual clinical symptoms, gender, age of patients, and the time of their admission to the hospital. The first group (42 patients) received treatment in accordance with the proposed method, the second (40 people) - in accordance with the existing one. In this case, treatment with antibiotics (gentamicin 80 mg 3 times a day intramuscularly), colloid (reopoliglyukin). crystalloid (quartasol) solutions, vitamins (ascorutin, cocarboxylase, calcium pangamate), glucocorticoids (prednisone, hydrocortisone) were the same in both groups.

The obtained data on the effectiveness of the treatment are statistically processed using Student t criteria and are presented in the table.

The table shows that the proposed method of treatment has statistically confirmed advantages over the existing one, consisting in accelerating the elimination of symptoms of toxicosis, manifestations of infectious colitis (hemocolitis), accelerating the repair of the mucous membrane of the large intestine, and shortening the hospital stay of patients by 6.2 + 0. 9 (P 0.05). This gives grounds for recommendations on the use of the proposed method for the treatment of patients with severe shigellosis in conditions of infectious hospitals.

PRI me R 1. Patient L., 32 years old, engineer, was admitted to the infectious diseases hospital on the 2nd day of the disease with complaints of severe weakness, nausea, repeated vomiting, cramping pain in the lower abdomen, fever ,, multiple loose stools mixed with mucus and blood. The disease is a group in nature and is associated with the consumption of sour cream. On examination, the general condition is severe, sick in la, adynamic. Temperature

39, b ° C, the skin is pale. The tongue is dry, covered with a whitish coating. Heart sounds are rhythmic, deaf, tachycardi. Pulse - 126 beats / min, rhythmic, weak filling and voltage. HELL - 90/40 mm

Hg The abdomen is soft, sigma is spasmodic, painful on palpation. Stool in the form of rectal spitting - a meager amount of oglizi with an admixture of blood, frequent tenesmus. From feces Shigella Flexner 1c, C

Taking into account clinical, epidemiological and bacteriological data, the diagnosis of acute Shigellosis of Flexner 1c, severe form, colitis variant was established. 80 gentamicin treatment prescribed

mg 3 times a day intramuscularly, reopoliglyukin - 400 ml intravenously, kvartasol was administered - 800 ml intravenously with the addition of 100 mg cocarboxylase, inside - calcium pangamate (vitamin Bis) per

0.05 g 3 times a day, ascorutin 1 tablet 3 times a day. 60 mg intravenous prednisone and 125 mg hydrocortisone suspension were administered intravenously in an isotonic sodium chloride solution.

In addition, splenin was administered 2 ml 2 times daily intramuscularly, acetylcysteine - 10 ml 10% solution 3 times a day intramuscularly (daily dose 50 mg / kg) and 5 g enterodesis 3 times a day, in the form of 3%

aqueous solution for oral administration.

Under the influence of the treatment, the patient's condition improved, the temperature normalized on the 4th day of treatment, chills disappeared, vomiting stopped, sleep and appetite returned to normal. On the 3rd day of treatment, tenesmus disappeared, on the 4th stool acquired a mushy consistency, visible macroscopic impurities of the blood disappeared. A sigmoidoscopy study on the 10th day of the treatment showed complete epithelization of erosion on the mucosa of the lower colon, the disappearance of swelling of the mucosa, and the absence of pathological impurities (mucus,

blood) in the intestinal lumen.

Sigma spasm disappeared on the 4th day of treatment, its compaction and sensitivity on palpation on the 7th day. With repeated bacteriological examination after

Shigella Flexner was not completed. The level of T-lymphocytes on the 10th day of the study was 52%, the phagocytic activity of neutrophils was 85%, the peroxide resistance of erythrocytes was 5%, the level of malondialdehyde was 64 mmol / l.

The total duration of inpatient treatment was 11 days, and was discharged by Ohm in satisfactory condition.

In this example, the smallest of the suggested doses of slenin is used (4 ml per day) and acetylcysteine (50 mg / kg body weight) for intramuscular administration. The second example shows the use of the maximum suggested doses of splenin (6 mg per day) and acetylcysteine (80 mg / kg body weight) when the latter is administered intravenously.

PRI me R 2. Patient M., 56 years old, was admitted to the infectious diseases hospital on the 2nd day of illness in an extremely serious condition, sharp weakness, adins, nausea, repeated vomiting, cramping pains in the lower abdomen, tenesmus, loose stools without counting in the form of rectal spitting - a meager amount of mucus uniformly stained with blood. From time to time, 5-10 ml of blood is released from the anus. The extremities are cold, the pulse is 140 d / min, rhythmic, weak filling filiform). HELL - 80/30 mm Hg left 60/20 mm Hg on right. The abdomen is soft, sharply painful upon palpation of the large intestine. Sigma is cramped, painful. Heart sounds are deaf. She does not urinate. Epidemically, the disease is of a group nature, associated with the consumption of sour cream.

The diagnosis of acute shigellosis, severe form, colitis, infectious toxic shock of the first degree. The diagnosis is further confirmed by bacteriological detection of Shigella Flexner 1c.

He was prescribed treatment with 80 mg gentamicin 3 times a day intramuscularly, reopoliglucin - intravenously, 400 ml, quartasol -1200 ml intravenously with cocarboxylase - 100 mg, cordiamine 2 ml, corglycon 0.06% .- 1 ml, prednisone 90 mg. A suspension of hydrocortisone, 125 mg in an isotonic sodium chloride solution, was administered intravenously. Inside, the patient received ascoruin, vitamin Bis (0.05 g 3 times a day), 5 g enterodez 3 times a day in the form of a 5% aqueous solution. Acetylcysteine was administered intravenously in a daily dosage of 80 mg / kg body weight in an isotonic sodium chloride solution 2 times a day. For this purpose, a 10% ampoule solution of acetylcysteine was dissolved in 90 ml of 0.9% sodium chloride to obtain a 1% solution of acetylcysteine, which was administered intravenously slowly (30-50 drops per minute). Exodus from the mass

5 bodies of patient M. (80 kg), she was injected with 320 ml of a 1% solution of acetylcysteine 2 times a day (6.4 g of the drug) for the first 3 days. Subsequently, after the elimination of severe manifestations of toxicosis, improvement of the general condition, reduction of diarrhea syndrome, acetylcysteine was administered intramuscularly in the form of a 10% solution at a dose of 50 mg / kg body weight (4 g per day) for 4 days to complete elimination of toxicosis.

5 Splenin was administered intramuscularly, 2 ml 3 times a day.

The patient's condition returned to normal, on the 4th day of treatment the fever disappeared, on the 10th edema and hyperemia of the intestinal mucosa. When bacteriological control re-Shigella not selected. The patient was discharged on the 12th day of the therapy in satisfactory condition.

Thus, the proposed method

5 treatment of patients with severe shigellosis has advantages over the existing one, consisting in increasing the effectiveness of the treatment and reducing ett time, reducing the frequency of protracted forms of shigellosis. The method is technically simple, does not require scarce and expensive drugs, and both ensures positive results in 95 + 5% of patients with severe

5, my shigellosis.

Claims (3)

Claims t. A method of treating patients with severe shigellosis with antibacterial drugs, colloidal and crystalloid solutions, vitamins and glucocorticosteroids, characterized in that, in order to increase the effectiveness and reduce the treatment time, 4-6 ml splenin is additionally prescribed per day 5 intramuscularly, acetylcysteine in a dosage of 50-80 mg / kg body weight and entodeodeapo 5 g 3 times a day by mouth. 2. The method according to claim 1, with the exception of the fact that acetylcysteine is administered intravenously in the form of a 1-3% solution or intramuscularly in the form of a 10% solution 2-3 times per day until elimination of infectious toxicosis. 3. The method according to claims 1 and 2, with reference to 5, so that the endodesis is prescribed in the form of an aqueous solution of 3-5% concentration.