RU2043106C1 - Method for treating acute intestinal infections in children - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering Indometacynum and Essenciale as a part of complex therapeutic treatment. Additionally 15% dimephosphon solution is injected at a dose of 15-20 mg/kg within succeeding 2-3 days after the complex therapy being over. EFFECT: enhanced effectiveness of treatment course; normalized metabolism.

Description

 The invention relates to medicine, namely to pediatrics for infectious diseases in children, in particular to methods for treating acute intestinal infections (AEI).

 The method of treatment of acute intestinal infections according to the claimed solution allows to successfully treat klebsiellosis, rotavirus infection, salmonellosis.

 The closest solution (prototype) to the claimed one is the method of complex therapy by L. N. Milyutina, I. V. Vorotyntseva et al: “Experience in treating indomethacin in young children with acute intestinal infections with watery diarrhea syndrome”. Magazine "Issues of Maternal and Child Health". 1989, N 4, p. 76, which allows the treatment of acute intestinal infections in children with watery diarrhea syndrome.

 A common essential feature of both decisions is conservative therapy with indomethacin, which coincides in dose and course of use of this drug.

 The treatment of acute intestinal infections by this method includes: the use of indomethacin at a dose of 0.0025 g 2-3 times a day for 1-5 days in the acute period of the disease with various etiologies of acute intestinal infections.

However, this prototype method has several disadvantages:
treatment by this method does not normalize the parameters of acid-base balance (ASC) in the early stages;
does not restore the integrity of the epithelium of the gastrointestinal tract in the early stages;
does not take into account other pathogenetic links in the development of acute intestinal infections;
Diagnosis of OCI in children was carried out in two stages in accordance with the available methodological recommendations of N.V. Vorotyntseva, L.N. Milyutina, O.A. Kanshina et al. "Differential diagnosis of acute intestinal infections in children" (1987).

 At the first stage, before the etiological decoding of acute intestinal infections, two syndromes were distinguished: watery diarrhea and colitis.

 Under observation were 31 children with watery diarrhea syndrome.

Children with watery diarrhea syndrome were divided into two groups:
treated by the prototype method (14 people)
treated by the claimed method (17 people).

 The data obtained showed that the clinical manifestations of watery diarrhea syndrome in children are similar in the acute period of acute intestinal infections, regardless of etiology.

In this case, the main clinical criteria for the appointment of the proposed therapy can be distinguished:
watery diarrhea syndrome,
mild to moderate severity
uncomplicated course
lack of concomitant pathology,
the appointment of therapy in the early stages of OCI (the first 3 days of the disease) without prior antibiotic administration.

 At the first stage of diagnosis, the analysis of the obtained data was carried out without taking into account the etiology (Table 1).

 From the table. 1 shows that against the background of treatment by the present method, the biochemical parameters in the coprofiltrates are normalized, reflecting the presence of the inflammatory process. The activity of phospholipase A and aggressive lysophosphatidylcholine is reduced. The content of lipid peroxidation products (diene conjugate) is reduced. The ratio of the phospholipid spectrum is restored. There is a significant decrease in the level of the intracellular enzyme 5-nucleotidase in coprofiltrates. The level of secretory IgA rises. This circumstance confirms that when using the proposed method, clinical recovery corresponds to the normalization of biochemical parameters in coprofiltrates. In the case of using the prototype method, there is no normalization of these biochemical parameters in coprofiltrates, although clinical efficacy is noted.

 At the second stage, after clarifying the etiological diagnosis, the data obtained were analyzed depending on the etiological forms. Among the observed children revealed: 20 patients with rotavirus infection, 9 patients with salmonellosis, 2 patients with intestinal infection of proteic etiology. Of 9 patients with salmonellosis, 5 people were treated by the proposed method without the use of antibacterial agents, indomethacin treatment by the prototype method (4 people) was carried out only simultaneously with the use of antibacterial agents. This fact did not allow to compare the effectiveness of the treatment by the prototype method and the proposed method.

 The greatest clinical material was obtained in the treatment of sick children with rotavirus infection. The data obtained are presented in table.2.

 Examples of specific applications of the proposed method for the treatment of acute intestinal infections in children are the following observations.

 The results shown in table 2 confirm the restoration of biochemical parameters in coprofiltrates with rotavirus infection while using the proposed method of treatment. In patients with rotavirus infection, the clinical effect of the proposed method coincided with the biochemical restoration of intestinal epithelium. The prototype method did not contribute to the normalization of biochemical parameters.

 PRI me R 1. Patient K. 7 months. medical history N 693. Clinical diagnosis: rotavirus gastroenteritis, moderate.

Received on the second day of the disease complaining of poor appetite, anxiety, weight loss, frequent loose, watery stools, vomiting single, the temperature to 37.8 ^C. acutely ill, temperature 37.8 ^C, frequent loose, watery stools up to 15 times in day, single vomiting.

 From the anamnesis: the child has an exudative catarrhal diathesis from 4 months, a food allergy to milk.

 Objectively: a state of moderate severity, lethargic, skin integument is pale, skin turgor is not reduced. In the throat calmly. Heart sounds are clear, the rhythm is correct. The tongue is moist, covered with a thin layer of white plaque. The abdomen is soft, rumbling upon palpation, moderately swollen. The stool is fluid, plentiful, watery, yellow in color, with a small amount of mucus. The diagnosis of rotavirus infection was confirmed by RNHA with erythrocyte diagnosticum in feces, RNGA titer 1:32 (analysis N 101). General blood and urine tests are normal. The treatment was carried out: oral rehydration in a volume of 50 ml / kg body weight. From the first day of the disease, complex therapy with indomethacin at a dose of 4 mg / kg was prescribed together with essentiale at a dose of 35 mg / kg for 5 days, then after cancellation of indomethacin, dimephosphon was prescribed at a dose of 20 mg / kg for 2 days. Normalization of temperature occurred on the 2nd day of the patient's stay in the hospital, on the 3rd day the symptoms of intoxication disappeared, appetite appeared. On the 4th day of hospitalization, stool returned to normal. The child spent 6 days in hospital, was discharged with recovery. Follow-up observation for 6 months showed the effectiveness of complex therapy, the child gained weight well, was not sick, and gastrointestinal tract dysfunction was not observed. The phenomena of exudative-catarrhal diathesis disappeared. The results are shown in table 3.

 The results of special biochemical and immunological studies of coprofiltrates in patient K. confirm the effectiveness of the proposed method. The restoration of biochemical parameters in this patient coincides with the timing of clinical recovery.

 PRI me R 2. Patient I. 2.5 months. medical history N 1555.

 Clinical diagnosis: Rotavirus gastroenteritis, moderate.

Received on the second day of the disease with complaints of temperature, poor appetite, loose stools. Acutely ill, temperature 39.6 ^C, abundant, watery stools up to 6 times per day, single vomiting. At admission: moderate, lethargic. The skin is pale, skin turgor saved. In the throat calmly. Heart sounds are clear, the rhythm is correct. The tongue is moist, covered with a thin layer of white plaque. The abdomen is soft, rumbling on palpation. The stool is fluid, watery, plentiful, foamy, with a little mucus. The diagnosis was confirmed by RNGA, titer 1:16 (analysis N 332). The results of a general analysis of blood and urine are within normal limits. The treatment was carried out: oral rehydration in a volume of 50 ml / kg body weight; from the first bottom, complex therapy with indomethacin was prescribed at a dose of 4 mg / kg together with essentiale (35 mg / kg) for 3 days, then after cancellation of indomethacin, dimephosphon was prescribed at a dose of 20 mg / kg for 2 days. Normalization of temperature occurred on the second day of the patient's stay in the hospital; on day 3, the child's condition is satisfactory, the symptoms of intoxication have disappeared; on the 4th day of hospitalization, stool returned to normal. The child spent in hospital 4 k / day. Discharged with recovery. The results are presented in table 4.

 This clinical example also confirms the clinical and biochemical effectiveness of the proposed method.

 PRI me R 3. Patient N. 1 g 3 months. medical history N 518. Diagnosis: Salmonella (Salmonella enteritidis), enteric variant, moderate.

Received on day 3 of the disease with complaints of decreased appetite, lethargy, weight loss, loose, plentiful, watery stools. Acutely ill, temperature 38.0 ^C, frequent copious watery stools greenish doped with a small amount of mucus. I was treated at home with a rehydron, oak bark, but no improvement came. From the medical history: mom fed the baby fried eggs. At admission: a state of moderate severity. The skin is pale, turgor of the skin is not changed. Mucous moist, calm in the throat. Heart sounds are clear, the rhythm is correct. The tongue is wet, coated with a white coating. The abdomen is soft, slightly swollen, rumbling upon palpation. The stool is plentiful, watery, greenish, with a little mucus. The diagnosis is confirmed by the isolation of Sal.enteritidis from the bowel movements. In the general analysis of blood: leukocytes 4.6˙10 g / l, eosinophils 1% stab neutrophils 1% segmented neutrophils 29% lymphocytes 61% monocytes 8% ESR 35 mm / h. The treatment was carried out according to the proposed scheme. During treatment, the temperature returned to normal on the first day of the patient’s stay in the hospital, the symptoms of intoxication disappeared on the second day, and the stool returned to normal on day 4. The patient spent 7 days in the hospital. Discharged with recovery. The results of the data are shown in table 5.

 This clinical example confirms the possibility of effective treatment of patients with salmonellosis with watery diarrhea syndrome. Clinical recovery coincides with the normalization of biochemical and immunological parameters in coprofiltrates, as can be seen from table 5.

 Thus, the above clinical observations indicate the achievement of a positive clinical effect and the normalization of biochemical parameters in coprofiltrates when using the proposed method. Using the prototype method does not lead to the normalization of biochemical parameters.

Claims (1)

 METHOD FOR TREATING ACUTE INTESTINAL INFECTIONS IN CHILDREN, including indomethacin therapy, characterized in that in the acute period the patient is additionally given essential at a dose of 35 mg / kg body weight for 5 days against oral rehydration followed by administration of dimephosphone at a dose of 20 mg / kg within 2 days after discontinuation of indomethacin.

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