RU2077335C1 - Method to treat acute purulent destructive pneumonia in children - Google Patents

Abstract

FIELD: medicine, pulmonology. SUBSTANCE: method deals with additional therapy with reaferon and unithiol according to certain scheme. As against the prototype the suggested method is of high efficiency. EFFECT: decreased risk of reinfectioning, lower intoxication degree, higher yield of specific antiviral antibodies. 1 tbl

Description

 The invention relates to medicine, namely to pulmonology, and for the treatment of acute purulent destructive pneumonia (OGDP) in children.

 Despite the significant successes achieved in the treatment of destructive pneumonia, its specific gravity in the mortality structure with purulent-septic pathology is more than 50%. As a rule, acute respiratory disease precedes the occurrence of acute respiratory infections, the frequency of which reaches 85%. Viruses affect upper respiratory tract mucosa and , reducing local immunity, create the prerequisites for the reproduction of the bacterial flora in the respiratory department of the lungs.

 Treatment of OGDP includes sanitation of the purulent focus, the conduct of antibacterial, detoxification, desensitizing and symptomatic therapy. However, such treatment is ineffective, often leads to reinfection, which is accompanied by severe intoxication and prolongation of hospitalization.

 The essence of the invention lies in the fact that for the treatment of OGDP use the genetically engineered drug reaferon and unitiol, taking into account the antiviral and immunomodulating effect of the former, according to a certain scheme against the background of conventional therapy.

 The treatment is as follows.

 Reaferon is dissolved in physiological saline at the rate of 250,000 IU in one milliliter of solution. The drug is administered at the rate of 50,000 IU / kg per day in two divided doses. In the morning, 1/2 daily dose is administered as inhalation. Reaferon is poured into the chamber of an ultrasonic inhaler TYR 50 and up to 10 ml of physiological saline is added. Duration of inhalation is 30 minutes. 30 minutes after the end of inhalation, unitiol is administered intravenously at the rate of 1 ml / year of life. If the child is shown tracheobronchioscopy, then instead of inhalation after the rehabilitation of the bronchial tree, 1/2 daily dose of reaferon is introduced into the bronchus from the affected side. After 30 minutes, unitiol is also administered intravenously.

 12 hours after the act of defection or a cleansing enema, the remaining 1/2 dose of reaferon is administered intrarectally to a depth of 4 cm using a catheter for catheterization of the subclavian vein.

 The essential features characterizing the invention are the use of reaferon in OGDP, doses and modes of administration of reaferon and unitiol, representing a new set of signs leading to the achievement of a positive effect in this disease.

 Introducing reaferon endobronchially, we bring a pathogenetically substantiated drug directly to the lesion. Despite inflammation of the bronchial mucosa from the affected side, a study of pharmacokinetics revealed higher peak increases in interferon levels than with inhalation, when the drug is absorbed through the bronchial mucosa of a healthy lung.

 Twice administration of the drug during the day is justified by the data on the pharmacokinetics of interferon, presented in the work of Soloviev V.D. and Bektemirova T.A. (1981).

 The introduction of reaferon into the ampoule of the rectum to a depth of not more than 4 cm is advisable because the capillary system of this section of the intestine is not included in the system of vein vein. This protects the administered reaferon from rapid inactivation in the reticuloendothelial system of the liver.

 The course of administration of reaferon and unitiol lasts 5 days. The introduction of drugs longer than the specified period did not give an additional clinical effect, and in some cases caused a leukemoid reaction. Reducing the course of treatment to 3 days does not give an immunomodulating effect, does not cause an increase in the titer of antiviral antibodies, does not increase the level of circulating interferon.

A clinical study of the proposed method was conducted. Under observation were 75 children aged 1-3 years with OGPD. They were divided into two groups:
I group of 22 children who received in addition to conventional therapy additionally reaferon and unitiol,
II group of 53 children who were not included in the course of conventional therapy reaferon.

 In the main group of children, along with conventional therapy, from the first day of hospitalization, reaferon at a dose of 50,000 IU / kg was administered for 5 days. Half the daily dose was administered by inhalation or endobronchial during tracheobronchoscopy in combination with the introduction of unitiol (1 ml / year of life). The second half of the daily dose was administered rectally after 12 hours.

 In the control group, children received antibacterial, infusion, symptomatic therapy, pleural punctures or drainage of the pleural cavity, and sanitation bronchoscopy.

 In both groups, a study was made of the dynamics of clinical indicators (course of infection, degree of intoxication, timing of improvement of clinical indicators, duration of antibiotic use, temperature reaction). For an objective assessment of the effectiveness of the treatment as criteria for comparing groups of patients, immunological and serological studies were carried out, and the interferon response of leukocytes (IRL) was determined before and after treatment (see table).

 Examples of specific performance of the method.

 Example 1. The medical history N 10411, patient A. Vorobchikov, 4 years old, was admitted to the children's thoracic department of hospital N 7 12/30/90, with a diagnosis of Acute purulent destructive pneumonia, pleurisy on the right. Sick from 12/22/90, when signs of SARS runny nose, fever. Treated on an outpatient basis. 12/28/90 the condition worsened, shortness of breath, abdominal pain appeared. Upon admission, the condition is serious due to hyperthermia, intoxication, respiratory failure. The pharynx is hyperemic. On the right, percussion shortening of the pulmonary sound, breathing on the right is sharply weakened. The abdomen is swollen. BH 32 per minute. Heart rate 112 per minute. On the chest x-ray on the right below the 11th rib, there is an inhomogeneous intense darkening, the external sinus is not traced. With pneumatic puncture received 90 ml of turbid effusion. Upon receipt in a smear from the nasal mucosa by immunofluorescence, a group A virus was detected. The level of serum interferon is 16 IU. Prescribed treatment: infusion therapy, cefobid, gentamicin, aminophylline, diphenhydramine. From the first day of hospitalization, reaferonotherapy was started: 750,000 IU per day for two doses (inhalation and rectal) for 5 days against a background of unitiol.

On the 3rd day of treatment with reaferon, the condition improved, the child became active, and appetite appeared. The temperature dropped to 36.7 ^o . It took only one 10-day course of antibiotic therapy. Performed 3 pleural punctures (90 ml, 40 ml, 0 ml). A serological study of paired sera with an interval of 10 days revealed an increase in the titer of antibodies to the type I parainfluenza virus. After the course, an increase in the level of serum interferon to 32 IU was revealed. The level of immunoglobulin decreased from 38 to 14 g / l. Plasma toxicity decreased from 0.185 to 0.34 conv. units By day 17, pneumonia was radiologically resolved. In satisfactory condition, the child was discharged on day 29.

 Example 2. The medical history N 744, patient Dzhubanova Z. 4 years old, was admitted to the DT-b-tsy N 7 01.02.91 with DZ: Acute purulent destructive pneumonia, pyopneumothorax on the right. Sick January 11, 91 cough, runny nose. Treated at home, there was no improvement. 01/21/91 was hospitalized in the Central District Hospital, where destructive pneumonia, pneumothorax on the right were revealed. Performed drainage of the pleural cavity. Transferred to DTO. Upon admission, the condition is serious, intoxication, respiratory failure, BH 38 per min. Prescribed infusion therapy (glucose, reopoliglyukin) and antibiotics kefzol and gentamicin. On day 2, the introduction of reaferon in a daily dose of 750,000 IU in two doses by inhalation and rectal administration was started. On day 4, during bronchoscopy, reaferon was introduced into the right main bronchus in a volume of 1 ml, then the upper lobe was occluded on the right. The course was carried out for 5 days. By this time, the temperature returned to normal, intoxication decreased, and the child became more active. The duration of antibiotic therapy is 14 days. A serological examination with an interval of 7 days revealed a 4-fold increase in the titer of antibodies to influenza B virus. After the course, the level of serum interferon increased from 8 to 64 IU. The level of immunoglobulin G decreased from 38 to 18 g / l. Phagocytosis increased from 50 to 68%. The seal was removed on the 11th day. Easy straightened. Discharged on day 32 in satisfactory condition.

 Example 3. Patient Antonova N. 1 year 9 months. medical history N 2013. Received on March 25, 1991, with diagnosis: Acute purulent destructive pneumonia, pleurisy on the left. She became ill on 10.03.91, when the temperature rose, a cough appeared. Treated at home, the condition did not improve. In the clinic on the x-ray revealed pneumonia. Upon admission, the child's condition is severe due to intoxication, respiratory failure. In the lungs on the left, shortening of the pulmonary sound and weakening of breathing. When pleural puncture received 40 ml of serous effusion. Prescribed infusion therapy (glucose 10%), antibiotics (ampicillin, brulamycin). Despite the fact that the child did not have clinical signs of a viral infection, influenza A virus was isolated from the smear taken from the nasal mucosa. From day 2, a course of reaferonotherapy was started in a daily dose of 500,000 IU twice in the form of inhalation and rectally against the background of intravenous administration unitiol after inhalation. On day 2, the condition improved slightly, the temperature decreased to subfebrile numbers, and by day 7 it returned to normal. In total, two pleural punctures were required. The duration of antibiotic therapy is 10 days. Serological examination with an interval of 7 days revealed an increase in the titer of antiviral antibodies to parainfluenza virus III. The number of T-lymphocytes increased from 56 to 62%. The titer of circulating interferon increased from 8 to 32 IU. Discharged in satisfactory condition on the 26th day.

 Thus, the claimed method has, in comparison with the prototype, several advantages: the risk of reinfection of patients is reduced; the length of hospital stay of patients is reduced; the degree of intoxication of the body in the acute period decreases; the production of specific antiviral antibodies is increased.

 The claimed method will expand the arsenal of methods for treating acute purulent destructive pneumonia in children and, apparently, will find wide application in medical practice.

Claims (1)

1 A method for the treatment of acute purulent destructive pneumonia in children, including sanitation of a purulent focus and antibacterial, detoxification, desensitizing and symptomatic therapy, characterized in that reaferon is additionally administered in a daily dose of 50,000 IU / kg body weight in two doses in the form of inhalation and / or enrobronchial and 12 hours rectally, and 30 minutes after inhalation, a 5% unitiol solution is administered intravenously at the rate of 1 ml / year of a child’s life, and treatment is carried out for 5 days.

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