RU2122861C1 - Method of treatment of children with pneumocystic infection - Google Patents

Abstract

FIELD: medicine, pediatrics. SUBSTANCE: method of treatment involves administration of antiparasitic agents and simultaneous administration of realdireon at doses 500,000-1,000,000 IU for 4-6 days depending on age. EFFECT: reduced disease time and relapse numbers, enhanced effectiveness of treatment. 2 ex

Description

 The invention relates to medicine, in particular to the treatment of infectious diseases.

 Known methods for the complex treatment of pneumocystis infection in children with the use of antiparasitic drugs: furazolidone, trichopolum, aminoquinol / Zinoviev G.A., Klimanskaya E.V., Mikhaleva G.V. Modern principles of treatment of children with recurrent and chronic bronchopulmonary diseases. Sat scientific tr L., 1987, S. 28 - 32 /.

 However, during treatment with this method, part of the patients experienced prolonged carriage of parasites, an exacerbation of the disease, and it was not always possible to cure the patient.

 As a prototype of the proposed method adopted a method of treating pneumocystosis in children / Parulava C.I. Pneumocystosis in children: clinic, diagnosis, treatment. Dis. Cand. honey. sciences. M., 1988, S. 110 - 117 / by simultaneous administration through the mouth of furazolidone and biseptol for 14 days, followed by 10-day intake of Trichopolum. Drugs were prescribed in usual age-related dosages.

 However, having a predominantly etiotropic orientation, this method of treatment does not contain an immunomodulating agent that can correct one of the main pathogenetic links of pneumocystic infection - secondary immunodeficiency. In some patients, relapses, the transition of the disease to a chronic form, and adverse outcomes were recorded.

 Our proposed method for the treatment of pneumocystosis includes oral administration of antiparasitic drugs: furazolidone, biseptol, Trichopolum in an age-specific dosage, 24-day course, as well as additional administration of recombinant interferon-realdirone in a dose of: once a day to children aged 1 year to 3 years for 500,000 ME, from 3 to 14 years - 1 million ME. The course of treatment with realdirone is 4 to 6 days.

 Realdiron is a genetic engineering alpha-2 interferon, has all its properties, is well purified and highly concentrated (1 ampoule contains 1 million ME activity).

 The inclusion in the complex of therapeutic agents of realdiron, which has an immunomodulatory effect, helps to improve some indicators of cellular and humoral immunity, allows reducing the duration of symptoms of intoxication and respiratory tract symptoms by an average of 2–5 days, reducing the patient’s hospital stay by 2–3 days, and reducing the number disease recurrence of 7%, prevent adverse outcomes of the disease.

 The method is as follows: a patient with pneumocystis infection takes through the mouth simultaneously furazolidone 4 times a day at a dose of 10 mg / kg per day and 2 times biseptol at a dose of 6 mg / kg per day for 14 days, then Trichopolum 2 times a day in daily dose: up to 2 years of 0.125 g, 2 - 5 years - 0.25 g, 5 - 10 years - 0.375 g, 10 - 15 years - 0.5 g for 10 days. At the same time, in the acute period of the disease, realdiron is administered intramuscularly to the patient once a day in a dose: for children from 1 year to 3 years old at 500,000 ME, from 3 to 14 years old - 1,000,000 ME for 4-6 days.

 Immediately prior to injection, the contents of the ampoule are dissolved in 2 ml of isotonic sodium chloride solution.

 Example 1. Patient L.N. 13 years old, medical history 6393 1992, fell ill on 11/15/92. Body temperature rose to 37.8, a dry, obsessive cough appeared. 11/16. shortness of breath joined. From the anamnesis it is known that since September 1992 a girl often has acute respiratory infections with obstructive syndrome, has been repeatedly treated with antibiotics.

 She was hospitalized on the 2nd day of the disease in the respiratory department of CST 2. Upon receipt, the condition is serious. Subfebrile fever. The skin is pale with a grayish tint, "shadow" under the eyes. The mucous oropharynx is hyperemic. Dyspnea of an expiratory character, number of breaths 46 per minute. In the lungs, on both sides, multiple moist small and medium bubbling rales were heard. Tachycardia up to 120 per minute. The presumptive diagnosis of pneumocystis infection was confirmed by immunofluorescence by detecting a large number of pneumocysts in different stages of development in sputum. Violations of the immunological status were revealed: Ig A 1.8, Ig M 5.2, Ig G 16.2, Tot. - 28, T act. - 21, T theoph. res. - 31, T theoph. Chuv. - 4, BM - 10%, latex test - 38%.

 Regarding pneumocystis infection proceeding in the form of severe obstructive bronchitis, treatment was prescribed: furazolidone 10 mg / kg / 50 mg 4 times a day / and biseptol 6 mg / kg / 1 table. 480 2 times a day / enteral for 14 days, realdirone intramuscularly 1 time per day for 1,000,000 IU for 5 days, vitamin E 5% - 1.0 intramuscularly 1 time per day 30 minutes after administration of realdirone, ascorbic acid 0, 1 three times a day. After taking furazolidone and biseptol, Trichopol was administered at 0.25 2 times a day for 10 days.

 Improvement was noted 2 days after the start of treatment. The temperature returned to normal, shortness of breath stopped, coughing became rare, productive, and the number of wheezing in the lungs decreased. By the 5th day of treatment, the catarrhal manifestations in the throat and wheezing in the lungs disappeared, by 6 - the cough passed. On the 10th day of complex treatment, positive changes in the immunological status of the patient were noted: CTT - 72%, T total. - 55, T act. - 32, T theoph. - 33, T theoph. Chuv. - 6, TJ - 36, BM - 20, latex test - 34%, IRI - 5.5. Single spasmocysts revealed in sputum. In satisfactory condition on day 11, the child was discharged home with the recommendation to complete the course of antiparasitic therapy on an outpatient basis. In the control analysis of sputum, conducted 10 days after the end of treatment, pneumocysts were not detected. Observation of the child in follow-up for 3 months did not reveal an exacerbation of the disease and carriage of parasites.

 Example 2. Patient E. 3 years. Medical history 7295 1992

She became acutely ill on 12/31/92. The temperature rose to 37.8 ^o C, a dry, obsessive whooping cough appeared, and breathing difficulties joined the next day. Hospitalized in the hospital on the 2nd day of illness. Diagnosis of ARVI, obstructive bronchitis.

 Upon receipt, the state of moderate severity, capricious, restless. The skin is pale, cyanosis of the nasolabial triangle. The mucous oropharynx is hyperemic. The chest is swollen. Breathing is quickened to 48 per minute, exhalation is significantly difficult. A large number of dry and single wet rales were heard in the lungs. Tachycardia up to 132 per minute. On the chest x-ray, an increase in pulmonary pattern was determined. Microscopy of sputum revealed a large number of pneumocysts and their young forms. Immunological data indicated immunodeficiency. 5.01.93 g: Ig A - 0.3, Ig M -1.4, Ig L - 8.8, T total. - 36%, T act. - 39, T theoph. Chuv. - 19, BM - 16%, latex test - 29, IRI - 2.8.

 After establishing the pneumocystic etiology of the disease, complex treatment was prescribed: furazolidone 10 mg / kg 0.03 4 times a day, biseptol 6 mg, 1 tab. 2 times a day, then Trichopol 0.125 twice for 10 days. At the same time, realdiron injections were started once a day for 500,000 ME for 5 days, 5% vitamin E and ascorbic acid.

 Improvement in health and well-being was noted after 3 days from the start of treatment: body temperature and appetite returned to normal, nasolabial triangle cyanosis disappeared, manifestations of bronchial obstruction changed, the number of wet rales decreased during auscultation of the lungs, and the cough became moist. Dyspnea completely stopped on the 5th day, cough on the 9th, wet wheezing in the lungs ceased to be heard on the 5th day, dry wheezing on the 8th day from the start of treatment.

 On the 17th day of complex therapy, the child in satisfactory condition was discharged home with a recommendation to complete the course of Trichopolum on an outpatient basis. When examined 10 days after completion of the course of treatment, pneumocysts were not found in sputum, positive dynamics of immunity indicators Ig A - 0.2, Ig M - 3.5, Jg - Y - 8.5, T total. - 26, T theoph. res. - 38, T theoph. Chuv. - 15, B mice. - 10, IRI - 2.5.

 Follow-up observation of the child for 3 months did not reveal a relapse of the disease.

 This method of treating pneumocystis infection can reduce the duration of the disease, reduce the number of relapses and improve the outcome of the disease.

Claims (1)

 A method for the treatment of pneumocystic infection in children, including the administration of antiparasitic drugs, characterized in that the patient is additionally administered realdiron at doses of 500,000-1000000 IU, depending on age, for 4-6 days.