RU2163130C1 - Method of treatment of patients with chronic tonsillitis - Google Patents

Abstract

FIELD: medicine, otorhinolaryngology. SUBSTANCE: method involves the use of licopid as immunomodulating agent that is administrated every day in a single daily dose 1 mg by sublingual route for 10 days to children and in the dose 10 mg to adults and sanitation of faucial tonsils is carried out with celandine solution. Treatment is carried out once for six months, not rare. EFFECT: enhanced effectiveness of treatment method.

Description

 The invention relates to medicine, namely to otorhinolaryngology, and may find application in the treatment of diseases of the upper respiratory tract.

 Tonsillitis is one of the most common diseases of ENT organs. At the heart of the disease is an infectious-allergic component, accompanied by a variety of violations of the immunological reactivity of the body, the causes of which may be endogenous and exogenous infection.

 It occurs with a change in the reactivity of the body associated with intoxication, general or local cooling of the body, etc. Most often, the infectious root cause is group A streptococcus, rarely Staphylococcus aureus. Having arisen once, tonsillitis often passes into a chronic form.

 The main methods of treating chronic tonsillitis are currently conservative and surgical. With a compensated form of tonsillitis, conservative treatment is indicated. Among conservative treatments, the most common is antibiotic therapy. Effective rehabilitation of tonsils, including washing, irrigation of the surface and tonsils lacunae, physiotherapeutic procedures. With a decompensated form of tonsillitis, surgery is indicated - tonsillectomy. However, in connection with an in-depth study of the role of the tonsils in the system of general immunoreactivity of the body, the approach to the treatment of tonsillitis has also changed: the surgical method is removal of the tonsils, in many cases it is carried out unjustifiably.

 It is known that the immune system of patients with chronic tonsillitis, and especially decompensated, is weakened by the pathogenic effect of the infectious agents themselves, as well as the result of long-term treatment with antibacterial, bactericidal, antiviral and other synthetic drugs. At the same time, a rapid growth of chronic infectious and inflammatory diseases, characterized by a sluggish continuously recurrent course, is currently observed. All this requires the use of active measures. Therefore, the development and implementation in clinical practice of effective means of combating chronic tonsillitis is an urgent task of modern medicine. Moreover, it should be noted that along with antimicrobial, anti-inflammatory drugs, it is necessary to use drugs that regulate or correct disturbances or weaken the immune system, caused either by the toxic effect of the infectious agent itself, or as a result of prolonged use of antibacterial and other synthetic dosage forms, i.e. . the drug should have a comprehensive, wide spectrum of action.

 In recent years, more and more attention in the fight against long-term and often recurring diseases has been given to the correction of the immune system through immunotropic drugs.

 Immunotropic drugs are drugs of synthetic and natural origin that can affect the immune response. Of greatest interest are drugs that correct the imbalance of various parts of the immune system (immunomodulators), since the use of such drugs is most relevant in the infectious process. This group of immunomodulating drugs includes products of bacterial origin, such as bacterial lipopolysaccharides (prodigiosan, pyrogenal), yeast polysaccharides (zymosan), ribosomal drugs (ribomunyl), and others. Among the immunotropic drugs, the most promising drugs are muramyl dipeptide series, which is a structural fragmentary cell wall bacteria. As well as immunity mediators - products of the immune system and auxiliary cells - lympho- and monokines (interleukins), as well as animal products - thymus hormones, including synthetic ones, such as thymosin, thymopoietin, thymostimulin, T-activin, velosene, thymogen etc. Immunomodulators of animal origin have proven to be quite effective means of correcting immune disorders in various diseases. Another group of immunostimulating drugs are synthetic substances, such as dibazole, levamisole, pentoxyl, methyluracil, pidotimoda, etc.

 Among immunoregulators, preference is given to drugs of natural origin. This is due to the fact that many synthetic immunomodulating agents not only do not give the desired effect, but also often cause negative reactions in the body: hepatotoxicity and nephrotoxicity, hematopoiesis inhibition, various allergic manifestations, reduce the body's resistance to viral infection.

 The present invention relates to the treatment of chronic decompensated tonsillitis.

 Closest to the proposed is a method of treating chronic tonsillitis decompensated form through the use of immunocorrective drug - thymogen. This method, taken as a prototype, consists of local and parenteral administration of thymogen [Khmelnitskaya N.M., Vorobyev K.V., Klyachko L.L., Ankhimova E.S., Maltseva G.S., Kosenko V. A., Medvedev E.A. // Efferent therapy., St. Petersburg, - 1997, - Volume 3, N 2, - S. 55-59].

 The method consists in sanitizing palatine tonsils with thymogen solution every other day in a pure form at a dose of 0.1-1.0% ml per wash, a total of eight to ten irrigation. For i / m use, 0.1% -0.5 ml was used daily for five days.

 The course of treatment was at least 20 days, and for 1 month the patient was under the supervision of a local therapist.

 The clinical effect of the use of thymogen in tonsillitis with frequent relapses of tonsillitis was evaluated as follows: a complete absence of tonsillitis in 10% of cases, a decrease in relapse (up to 1-2 times per year) of angina in 80% of cases. Lack of clinical effect in 10% of cases.

 The use of thymogen alone is insufficient, since only 10% of patients experienced persistent remission (no relapse) for one year, and in the remaining patients, recurrence of tonsillitis (tonsillitis), although less frequently, continued.

 As our experience of observing patients shows, remission after such treatment did not exceed 2-3 months, and patients during this period suffered from acute respiratory viral infections and exacerbations of concomitant diseases were observed. Already with minor hypothermia, violation of the regime, stress, malnutrition, the disease again exacerbated. The course of concomitant diseases worsened. All this required repeated courses of treatment. Even the repeated administration of such immunocorrective therapy did not always prolong the remission, and the treatment was long. Since thymogen is an immunomodulator of animal origin and created synthetically, it often caused side effects, namely allergic reactions and exacerbation of latent viral infections.

 All this indicates the lack of effectiveness of immunocorrective therapy using thymogen in chronic tonsillitis, especially decompensated form. In most cases, treatment of patients ended with tonsillectomy. In this regard, in recent years, the use of thymogen for the treatment of chronic tonsillitis decompensated forms have practically been abandoned.

 The technical result of the present invention is to achieve a more stable remission in patients with a decompensated form of chronic tonsillitis.

 This is achieved by the fact that in the known method of treating tonsillitis by immunocorrective therapy with simultaneous sanitation of the tonsils according to the invention, a patient aged 1 to 16 takes a sublingual lycopide 1-2 (1 mg) tablets in the morning before meals for 10 days, and after 16 years, takes sublingually lycopid 1 tablet (10 mg) in the morning before meals for 10 days, and for the rehabilitation of palatine tonsils, an activated infusion of celandine grass is used.

 It is advisable to conduct repeated courses, especially in the autumn-spring period, when frequent colds are observed, exacerbations of many infectious diseases, leading to a weakening of the body's immunobiological system.

 Having been professionally involved in the treatment of diseases of the upper respiratory tract for many years, including the pathology of the lymphopharyngeal ring, we noticed that the currently used immunocorrective therapy (thymogen, prodigiosan, levamisole) is not effective enough. Since it has an immunocorrective effect, mainly only on individual links of the immune system, or on the phagocytic link, or on the cellular and humoral immunity, but also does not affect infectious and microbial agents, it has undesirable side effects. All this leads to further chronization of the infectious process, exacerbation of the imbalance in the systems of general and local immunity, allergization of the body.

 This prompted us to search for immunomodulating drugs with a wide, complex spectrum of action on the main pathogenetic links of the disease. We tested a number of immune preparations, however, we focused on the drug, the active principle of which is a component of the bacterial wall and is a natural stimulator of the human immune system - lycopid. Lycopid acts on all three main components of the immune system: phagocytosis, cellular and humoral immunity. It combines anti-infectious, antibacterial, antifungal, antiviral, anti-inflammatory effect. In addition, the harmlessness of lycopid was noted, which is confirmed by the absence of any toxic or side effects, locally irritating effect on the skin, mucous membrane of the oral cavity and gastrointestinal tract.

 This drug is used in medical practice for non-specific diseases of the lungs, bronchi, with various forms of pulmonary tuberculosis, purulent-inflammatory processes of the skin and soft tissues, in gynecology, for herpetic lesions of the mucous membranes, in patients with psoriasis, etc. For the treatment of diseases of ENT organs, in particular chronic tonsillitis, has not been previously used.

 Given that the drug is of natural origin and created from the walls of microorganisms, has a wide spectrum of action, we decided to try to use it in patients with chronic decompensated tonsillitis.

 The treatment was carried out in patients admitted to the institute after a long ineffective treatment with traditional methods (conservative methods: antibacterial therapy, anti-inflammatory drugs, palatine tonsillitis furacilin, physiotherapeutic methods), with sluggish, long-term and frequent recurrence of tonsillitis, in which, nevertheless, no improvement was achieved and tonsillectomy was recommended.

 Lycopide was prescribed sublingually daily for 10 days, 1-2 tablets (1 mg) in the morning before meals for children aged 1 to 16 years, and adults (after 16 years) 1 tablet (10 mg) daily for 10 days morning before meals. Already 3-4 days after the start of treatment, an improvement in the general condition and a decrease in the phenomena of intoxication were noted.

 Moreover, the positive effect we achieved was confirmed by the improvement of indicators: a clinical blood test (the number of leukocytes, eosinophils and ESR had normal values), blood immunograms and exocrine secrets (the functional activity of phagocytic blood cells, an increase in the level of secretory immunoglobulin A in saliva, immunoglobulin E in the blood), immunological function of the tonsils. This indicates a persistent improvement not only in subjective, but also in objective indicators.

 Using our experience in treating chronic tonsillitis with celandine infusion, its bactericidal effect against S. aureus strain, we additionally rehabilitated the tonsils with celandine infusion to enhance the effect on the local focus of inflammation.

 Irrigation therapy with activated infusion of celandine grass promotes faster cleansing of the tonsils from pathological contents, faster removal of inflammatory phenomena, relieves edema and hyperemia from the mucous membrane of the tonsils, improves trophism. Due to this, by the end of treatment, a decrease in bacterial contamination by pathogenic forms of the contents of the gaps was noted.

 The essence of the present invention is as follows.

 After clinical and laboratory diagnosis of chronic decompensated tonsillitis, a complex treatment of the disease is performed, consisting in a combination of sublingual use of lycopid and debridement of the tonsils with infusion of celandine. The treatment regimen was found by us empirically. Within 10 days, a sublingual intake of lycopide in patients is 1-2 tablets (1 mg) in children (1 year to 16 years) and 1 tablet (10 mg) in adult patients (after 16 years). The drug is taken 30-40 minutes before a meal.

 Remediation of palatine tonsils is carried out with activated infusion of celandine herb in the calculation of 15 ml per tonsil, daily for 10 days. We recommend conducting such courses at least once every 6 months in order to prevent the inflammatory process in the tonsils.

 The treatment regimen was found by us empirically, depending on the age of the patient, the severity of the chronic process in the tonsils and the frequency of relapses. The effect of different doses of lycopid to achieve the antibacterial and immunomodulating effect in children and adults was studied. In childhood (from 10 years to 16 years), the drug was initially taken orally in a dose of 0.5 mg per day, then 1 mg per day, gradually came to a dosage of 1-2 mg per day. In adult patients, the most effective dose was also experimentally found - this is 1 tablet (10 mg) 1 time per day. It is shown that the most effective is the sublingual administration of the drug, which provides the most powerful local anti-inflammatory effect. In addition, according to our research, the most effective is to take lycopid before meals, i.e. 30-40 minutes before eating.

 The essence of the method is illustrated by examples.

 Example 1

 Patient P., born in 1988, outpatient card N 3769, turned to the NOR ENT on October 12, 1999 with complaints of frequent viral diseases (every 2-3 months), frequent tonsillitis (up to 5-6 times a year), weakness, sweating, fatigue. Sick since childhood, was repeatedly treated on an outpatient basis (broad-spectrum antibiotics were used, to which allergic reactions in the form of skin rash, immune preparations have begun to appear in recent years, palatine tonsils have been sanitized repeatedly with furacilin, physiotherapeutic methods, as well as homeopathic therapy), but not effective enough . Surgical treatment, tonsillectomy, was recommended to the patient at the community clinic.

 With pharyngoscopy: the mucosa of the pharynx and posterior pharyngeal wall is sharply hyperemic, hypertrophy of the palatine tonsils of the 2nd degree, the presence of adhesions between the palatine tonsils and palatine arches, the presence of purulent-caseous contents in the gaps. From the rest of the ENT organs, there were no signs of pathology. Regional lymph nodes are enlarged to 1 cm in diameter, painless.

 In the blood test at this time, L - 10.2, eosinophilia - 15%, accelerated ESR (25 mm), which indicates the presence of an inflammatory process and allergization of the body. The immunogram shows signs of inhibition of the phagocytic system of immunity, with the presence of sensitization to staphylococcal antigen (phagocytosis in neutrophils - 38%, phagocytic index in neutrophils 3.81 units, RTML with hemolytic staphylococcus allergen 133%). Violations of the immunogram in exocrine secrets were noted (the content of immunoglobulin A in saliva was increased - 0.152, which proves the presence of an acute inflammatory process in the body). Allergization of the body was detected, an increased content of immunoglobulin E in the blood (250 KE / l) was detected. The function of the palatine tonsils is sharply reduced (the content of lymphocytes in the contents of the gaps of the palatine tonsils was 10 cells in one large square of the Goryaev chamber). Bacteriological examination of palatine tonsil material revealed an increase in microbial seeding, with the presence of Staphylococcus aureus in the flora (65,940 microbial units in the right and 26379 in the left tonsil; S. aureus in the right tonsil amounted to 49,500 units and in the left - 20,350 units )

 Based on the examination data, medical history, and laboratory examination results, chronic decompensated tonsillitis was diagnosed.

 The patient was offered conservative treatment using lycopid. Daily for 10 days, sublingually on an empty stomach, 1-2 tablets in a dose of 1 mg. At the same time, irrigation therapy with activated infusion of celandine grass was carried out. Every day, according to one procedure, for each tonsil, 15-20 ml of solution was consumed. On day 5-6, the patient noted an improvement in overall health, weakness, sweating decreased. With pharyngoscopy: palatine tonsils cleared of pathological contents, decreased hyperemia of the palatine arches. After the course of treatment, the state of health improved significantly: he did not show complaints of soreness in his throat, and his working capacity increased. A positive clinical picture was observed: tonsils decreased in size, hyperemia of palatine arches disappeared, lymph nodes decreased. In the blood test, eosinophilia decreased to 5%, the number of leukocytes (4.3), ESR (3 mm / h) normalized. The immunogram picture stabilized, sensitization to staphylococcal antigen disappeared (phagocytosis in neutrophils 58%, phagocytic index in neutrophils 4.62 units, RTML with hemolytic staphylococcus allergen 90%). The content of immunoglobulin A in saliva normalized (0.05 g / l), which proved the absence of an inflammatory process, and the normalization of immunoglobulin E in the blood (80 KE / l) indicated the absence of sensitization in the body. The immunological function of palatine tonsils increased (the number of lymphocytes was 60 cells per one large square of Goryaev’s chamber), bacterial seeding due to pathogenic flora in the contents of the palatine tonsils decreased (total bacterial seeding amounted to 16425 on the right and 6000 microbial units on the right; pathogenic flora on the right tonsil 3451, and in the left tonsil 1874 microbial bodies). The patient was discharged in satisfactory condition with the appearance for re-examination after six months. At the follow-up examination after six months: exacerbations of chronic tonsillitis were not observed, during this period SARS did not hurt. Laboratory indicators are also within normal limits.

 Currently, the patient continues to be observed.

 To date, the proposed method has been used to treat 16 patients with decompensated chronic tonsillitis complicated by the presence of concomitant pathology. It has been prescribed to patients who are weakened, with the presence of intoxication phenomena, with a sluggish, recurrent inflammatory process, which were previously treated on an outpatient basis and in the hospital with conservative methods, but after treatment there were frequent relapses of tonsillitis (up to 5-6 times a year), frequent SARS (every 2-3 months) and they were recommended surgical treatment - tonsillectomy.

 Likopid for children was prescribed 1-2 tablets sublingually in the morning on an empty stomach, 1 time per day for 10 days. For adult patients, he was recommended once 1 tablet (10 mg) sublingually in the morning before meals for 10 days and at the same time, palatine tonsils were sanitized with activated celandine infusion.

 The use of lycopid, as shown by our studies to date, leads to a persistent positive therapeutic effect. According to the results of clinical and laboratory studies, among 14 (87.5%) patients, a stable result was achieved, as evidenced by both an improvement in well-being and blood counts, i.e., there were no relapses of tonsillitis and they did not have ARVI, only 2 patients (12 , 5%) suffered ARVI. In patients with chronic decompensated tonsillitis, we managed to achieve a stable remission in 6 months, during the autumn-spring period there were no exacerbations of the disease and they continue to be observed. This is facilitated by repeated courses of treatment.

 The proposed method compared with the known one has significant advantages, the main one of which is that the method provides a stable remission, which is currently more than six months, and patients continue to be observed without recurrence of the disease.

 The method was developed in the laboratory department of the Research Institute of ENT and was tested in 16 patients with chronic decompensated tonsillitis with the achievement of a positive therapeutic effect.

Claims (1)

 A method of treating chronic tonsillitis by immunocorrective therapy with simultaneous rehabilitation of the tonsils, characterized in that lycopid is used as an immunomodulator, which is administered once daily, 1 mg sublingually for children and 10 mg for adults, and palatine tonsils are sanitized, moreover, treatment is carried out at least once every six months.