RU2048811C1 - Method of enhancement of antibiotic therapy efficiency - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves the use of the means 0.1% epinephrine added at quantity 0.05 ml per one antibiotic injection. EFFECT: maintenance of constant high level of antibiotic in blood at treatment course.

Description

 The invention relates to medicine, namely to antibiocotherapy of inflammatory, infectious and tumor diseases.

A known method of antibiotic therapy based on the use of an antibiotic and auxiliary medicinal substance hydroxyaryl- or hydroxyaralkylcarboxylic acid or its derivative [1]
Its disadvantage is the oral route of administration, especially in patients operated on in the gastrointestinal tract, as well as in severe patients.

 These disadvantages are deprived of the method in which the increase in the activity of antibiotics and antitumor agents is carried out by adding to them caffeine of dimethylthiocyanin or pyronin in [2] This method is acceptable only for a limited number of antibiotics (phleomyzin, bleomycin, tallisomycin).

 The aim of the invention is to maintain a constantly high level of antibiotic in the blood during the entire treatment.

 The goal is achieved in that 0.05 ml of 0.1% adrenaline solution (0.05 mg) per 1 injection is added to the antibiotic solution for intramuscular administration.

 A dose of adrenaline of 0.05 mg (0.1% 0.05 ml) was chosen empirically by selection, for which a series of experiments on animals were performed (50 dogs). In the experiment, the antibiotic content (benzylpenicillin sodium salt) in the arterial blood, venous blood, and thoracic duct lymph was determined, and histological examination of muscle tissue was performed, where the antibiotic was administered in a standard dosage of 10,000 units per 1 kg of weight.

 The adrenaline solution was used in an increasing dose from 0.01 mg to 0.25 mg, and the results were compared with a control group (10 dogs) in which standard antibiotic therapy was performed without adrenaline. The experiments showed that a decrease in the dose of adrenaline of less than 0.05 mg led, on the one hand, to the fact that the antibiotic quickly (within 2.5-3 hours) left completely the blood and lymphatic channels, and these results were statistically insignificant compared with control group (i.e., they approached the latter and had a significant drawback: between the intervals of antibiotic administration, time intervals formed when the content of the antibiotic was at the level of the minimum therapeutic concentration, or its traces were determined, or it completely determined). With an increase in the dose of adrenaline over 0.05 mg, the antibiotic content in the blood and lymph was maintained at a constant high level, but the disadvantage was that histological examination revealed in 80% of cases large-focal necrosis of muscle tissue in the place where the antibiotic with adrenaline was administered, which could lead to the formation of post-injection infiltrates and suppurations. This is due to an increase in the exposure time of the antibiotic with muscle tissue due to spasm of local vessels. The use of 0.05 mg of adrenaline per 1 injection was accompanied by its high concentration in the blood and lymph and minimal histological changes (swelling of muscle tissue with hemorrhages, in 30% of small and large focal necrosis of muscle tissue).

 Adding 0.05 mg of adrenaline to the antibiotic can slow the absorption of the antibiotic from the muscle due to spasm of local vessels, thereby contributing to its slow and uniform entry into the blood (usually the antibiotic from the muscle is rapidly absorbed and also leaves the bloodstream quickly) and creates the maximum concentration in the blood (since the intramuscular route of administration corresponds to the intravenous).

 The proposed method treated 12 patients with surgical pathology. When studying the content of the antibiotic in the blood, its constant high level was observed during the entire treatment. Allergic reactions and local post-injection complications have not been identified. Thus, the method meets the criterion of "novelty." Comparison of the proposed method not only with the prototype, but also with other solutions in this field of medicine did not allow to reveal in them the signs that distinguish the proposed solution from the prototype, which allows us to conclude that the criterion of "significant differences".

 PRI me R 1. Patient A. was admitted to the surgical department in serious condition with a diagnosis of blunt trauma to the abdomen, peritonitis. An operation was performed on an emergency basis: laparotomy, suturing of the wound of the small intestine, drainage of the abdominal cavity. Immediately after the operation, antibiotic therapy was started against the background of ongoing infusion therapy. Antibiotic therapy was carried out with benzylpenicillin (sodium salt) at 1 million units 6 times a day and kanamycin sulfate at 0.5 g 2 times a day. Antibiotics were administered intramuscularly and 0.05 ml of 0.1% adrenaline solution (0.05 mg) was added to each injection. Blood samples were taken through the subclavian catheter from the superior vena cava to determine the content of antibiotics in it to monitor their level. The duration of antibiotic treatment is 5 days.

 Control determination of antibiotics in the blood revealed that their level was constant and no significant difference in concentration between time intervals was found.

On the second day of the patient's condition improved, low-grade 37.3 ^{° C} temperature, tachycardia decreased from 120 minutes to 1 to 92 to 1 min. Blood pressure remained stable. Peristalsis was not heard, the stomach was not swollen.

There were no phenomena of hepatic-renal failure (clinically and laboratory). Leukocytosis decreased from 14 x ^{10 9} / L to 12 x 10 ⁹ / L. In the exudate from the abdominal cavity (100 ml per day) obtained from the drains, leukocytosis remained up to 20 x 10 ⁹ / l, and the microbial number was 10 ⁵ in 1 ml. The level of antibiotics in the exudate did not significantly differ from the content of antibiotics in the blood. On the third day the positive dynamics in the patient's condition is preserved: normalized temperature (36.8 ° ^C), disappeared tachycardia (heart rate at 76 min) appeared intestinal peristalsis. In the exudate from the abdominal cavity (10 ml per day), leukocytosis decreased to 10,000 / l, and microbial bodies were not detected. The number of white blood cells in the blood decreased to 8 x 10 ⁹ / L. Given the stable improvement in the patient's condition: normalization of the function of the intestinal tube (independent peristalsis) and scanty separation from the abdominal cavity through the drains, the latter are removed. From the fourth day the patient is active, eats a liquid diet (1 table), there was no increase in temperature. Physiological settings are normal. On the 5th day, antibiotics are canceled. Sutures were removed on the 10th day. No temperature reaction, purulent complications were subsequently revealed. Discharged in satisfactory condition home.

 Thus, the use of the proposed method allows effective antibiotic therapy by maintaining a high concentration of the antibiotic in the blood at a constant level during treatment.

Claims (1)

 METHOD FOR INCREASING THE EFFICIENCY OF ANTIBIOTIC THERAPY by using an auxiliary substance, characterized in that they use a 0.1% solution of adrenaline, which is added to the antibiotic in a volume of 0.05 ml per injection.