RU2200025C2 - Method of treatment of chronic chlamydiosis prostatitis resistant to conventional therapy - Google Patents

Abstract

FIELD: medicine, urology. SUBSTANCE: invention proposes to use immunomodulating agent lycopide depending on the parent activity of cells of neutrophile-leukocyte order. In increase of activity in lymphocytic order: CD 25+ > 16, CD 71+ > 4, HLA-DR > 30; in monocytic order: CD 25+ > 30, CD 71+ > 35, HLA-DR > 70 and in neutrophile order: HCT > 28 and HCT3 > 38 lycopide is prescribed in the dose 10 mg by sublingual route every day before eating in course dose 1 g in combination with prescription of macrolide order antibiotics in therapeutic doses. In reduction of activity in lymphocytic order: CD 25+ <10, CD 71+ <1, HLA-DR <19; in monocytic order: CD 25+ <20, CD 71+ <30, HLA- DR <60 and in neutrophile order: HCT <17 and HCT3 <27 lycopide is prescribed in the dose 10 mg by sublingual route every day before eating in course dose 1 g and intake of macrolide antibiotics in therapeutic doses is prescribed beginning from 5-th day of lycopide treatment onset. Method allows to reduce treatment period and diminish course dose of antibiotics. Invention can be used for treatment of chronic chlamydiosis prostatitis resistant to conventional therapy. EFFECT: improved method and enhanced effectiveness of treatment. 4 tbl, 2 ex

Description

 The invention relates to medicine, namely to urology, clinical immunology, and can be used to treat chronic chlamydial prostatitis (CKP) that are resistant to standard therapy. The standard therapy for urogenital chlamydia is well known and consists in the use of antibiotics - macrolides for 10-14 days (Diagnosis, treatment and prevention of sexually transmitted diseases. // Method. Materials edited by prof. K.K. Borisenko. - M. , 1997.S. 40). However, antibiotic therapy is not always effective enough. The known fact of the suspension of metabolic processes in the reticular bodies of chlamydia with prolonged persistence of the pathogen, which reduces the effectiveness of "pure" antibiotic therapy and requires a special approach (Immunotherapy for chronic persistent urogenital chlamydia. // MA Gomberg et al., Journal of Sexually Transmitted Diseases. - 1997 4.S. 34-36). In this case, emphasis is needed on immunotherapy, which affects the specific reactivity of the body.

 Closest to the proposed method is a method of treating patients with urogenital chlamydia using an immunomodulator cycloferon (Cycloferonum, polysan), which consists in the combined use of antibiotics and cycloferon according to a scheme lasting 23 days, and it is mandatory to conduct 2-3 basic courses with a change of antibiotics (Reference. Vidal, Medicinal Products in Russia, M., 1998. S. 638).

However, this method of treatment has several significant disadvantages:
1) prolonged use of antibiotics in the treatment of CKP can lead to the formation of immunological deficiency,
2) violates the intestinal biocenosis and contributes to the development of dysbiosis,
3) cycloferon requires invasive (intramuscular) administration and strict adherence to the proposed long-term regimen.

 This method was chosen by us as a prototype.

 These disadvantages are eliminated in the claimed method.

 The technical result of the proposed method is to reduce the treatment time, increase the effectiveness of treatment and increase the duration of remission in CKP, resistant to standard therapy.

 This goal is achieved by the fact that for the treatment of CKP resistant to standard therapy, it is proposed the differentiated use of the immunomodulator lycopid (Licopid, peptec) in conjunction with the antabiotic macrolide sumamed (Sumamed - Azythromycin, pliva) and tincture of eleutherococcus depending on the degree of initial neutrophilic, lymphopitar and monocytic activation.

 With a high activity of neutrophilic, lymphocytic and monocytic cells, it is proposed to use lycopide 10 mg sublingually daily in the morning at a course dose of 1 g together with sumamed 1 g on the first day of treatment and then 500 mg orally, only 6 g per course of treatment. Reception of lycopid and sumamed must be started at the same time.

 With a low activity of neutrophilic, lymphocytic and monocytic series, treatment should be started with the first intake of lycopide 10 mg sublingually daily in the morning, at a course dose of 1 g and tincture of Eleutherococcus 15 drops 2 times a day in order to stimulate neutrophilic and monocytic activity by stimulating the formation of cell energy reserves (ATF, etc.). From the fifth day of treatment, sumamed 1 g is added to the specified therapy on the first day and then 500 mg orally, only 6 g per course. Mandatory prescription of antioxidants (tocopherol acetate 200 mg 2 times a day by mouth) throughout the course of treatment.

 A condition for prescribing immunomodulatory therapy with lycopid is an immunological examination that allows you to objectively assess the initial degree of lymphocytic, monocytic and neutrophilic activation, which determines the treatment tactics (see Tables 1 and 2), and the absence of an immunostimulatory and immunosuppressive therapy in the history.

 The proposed method was used in outpatient treatment of 35 patients. Clinical and laboratory cure occurred in all patients. After applying the proposed method for the treatment of CKP resistant to standard therapy, no relapse was observed during the observation period of 1-12 months. While using standard therapy before treatment with the proposed method in these same patients, relapses occurred after 1-3 months.

The advantages of the proposed method:
1. The proposed method allows to reduce the time of treatment of CKP resistant to standard therapy, up to 10-14 days, while when using the prototype method requires 23 days.

 2. The proposed method allows to reduce the dose of an antibacterial drug, thereby preventing the side effects of antibiotic therapy.

 3. Differentiated depending on the activity of cells of the monocytic and neutrophilic series, the appointment of immunomodulating therapy avoids the side effects of empirical immunocorrection.

 The novelty of the proposed method lies in the fact that for the first time a differentiated approach is proposed in the use of an immunomodulator lycopid (Licopid, pepec) in combination therapy with the antibiotic sumamed (Sumamed-Azythromycin, pliva) and the adaptogen Eleutherococcus for the treatment of chronic chlamydial prostatitis resistant to standard therapy, in depending on the level of initial activation of cells of the neutrophilic, lymphocytic and monocytic series.

 Examples from the clinical application of the method.

 Example 1

 Patient P., 30 years old.

 Complaints of periodically spontaneous mild pain in the perineum, both inguinal regions, radiating to the left testicle, periodic mucous discharge from the urethra in the morning, accelerated ejaculation.

 Suffers from chronic chlamydial prostatitis for 2 years, during this time he underwent 2 courses of special treatment, including inpatient, without a lasting effect.

Objectively:
Hypersthenic, physical development is satisfactory, male-type body hair, and the external genitalia are developed correctly. There is no hyperemia of the urethral sponges, no discharge from the urethra was detected. The testicles in the scrotum, normal structure and size, appendages differentiate, painless on palpation.

 Per rectum: The prostate is of normal size and shape, somewhat doughy consistency, moderately painful to palpation.

 Ultrasound of the prostate, bladder, seminal vesicles.

 The bladder with a smooth inner contour, physiological capacity.

 Prostate with clear contours, sizes 28 • 40 • 34 mm, unevenly increased echo density, homogeneous structure, interlobar groove pronounced.

 Seed vesicles are symmetrical, dimensions: left 11 mm, right 9 mm, their contents are homogeneous. The testes are located in the scrotum, with even clear contours, the structure of the testicles is homogeneous, the echo density is uniform. Testicle sizes: right 37 • 20 mm, left 39 • 23 mm.

 Smear from the urethra.

- White blood cells 2-3 in the field of view
- Epithelium polymorphic - ++
The secret of the prostate.

- White blood cells 20-25 in the field of view
- Red blood cells - no
- Lecithin grains - ++
Urogenital chlamydia was diagnosed by ELISA ("MultiScan"), the test material is the secret of the prostate gland.

 Clinical diagnosis: Chronic chlamydial prostatitis, recurrent course.

 Immunogram (see table. 3).

An immunological examination showed:
Increased activity of early activation markers for CD25 +, CD71 + cells and late activation markers for HLA-DR antigen in lymphocytic and monocytic gates. Despite the high initial level of HCT activity of polymorphonuclear leukocytes, insignificant functional reserves of intracellular energy activity of neutrophils after stimulation with zymosan are preserved.

 The day of the immunocorrective therapy, an immunomodulator lycopid (Licopid, pepec) was used sublingually 10 mg daily, in a course dose of 1 g together with sumamed (Sumamed-Azythromycin, pliva) on the first day of treatment 1 g, then 500 mg, only 6 g per course treatment. The simultaneous administration of lycopid and sumamed was prescribed.

 Example 2

 Patient M., 28 years old.

 Concerned by moderate moderate pain in the perineum, testicles, aggravated after ejaculation, quickening of mycosis up to 9-12 times a day, night pollakiuria up to 1-2 times, periodic mucous discharge from the urethra, mainly in the morning or after defecation.

 Suffers from chronic chlamydial prostatitis for 1.5 years, during this time he underwent 2 courses of special treatment in the clinic at the place of residence, without a lasting effect.

Objectively:
Normostenik, physical development is satisfactory, male-type body hair, and the external genitalia are developed correctly. There is no hyperemia of the urethral sponges, no discharge from the urethra was detected. The testicles in the scrotum, normal structure and size, appendages differentiate, painless on palpation.

 Per rectum: The prostate is of normal size and shape, somewhat doughy consistency, moderately painful to palpation.

 Ultrasound of the prostate, bladder, seminal vesicles.

 The bladder with a smooth inner contour, physiological capacity.

 Prostate with clear contours, sizes 27 • 37 • 33 mm, unevenly increased echo density, homogeneous structure, interlobar groove pronounced.

 Seminal vesicles are symmetrical, of normal size, their contents are homogeneous. The testes are located in the scrotum, with even clear contours, the structure of the testicles is homogeneous, the echo density is uniform. Testicle sizes: right 44 • 20 mm, left 39 • 21 mm.

 Smear from the urethra.

- White blood cells 1-2 in the field of view
- Epithelium polymorphic - ++
The secret of the prostate.

- White blood cells 15-20 in the field of view,
- Red blood cells - no
- Lecithin grains - ++
Urogenital chlamydia was diagnosed by ELISA ("MultiScan"), the test material is the secret of the prostate gland.

 Clinical diagnosis: Chronic chlamydial prostatitis, recurrent course.

 Immunogram (see table. 4).

An immunological examination showed:
Decreased activity of early activation markers for CD25 +, CD71 + cells and late activation markers for HLA-DR antigen in lymphocytic and monocytic gates. An increase in the relative indices of the spontaneous bactericidal activity of neutrophilic HCT cells, a decrease in the supply of intracellular neutrophil activity after stimulation with zymosan.

 To carry out immunocorrective therapy, lycopide (Licopid, pepec) was administered sublingually 10 mg daily in the morning before meals for 4 days and sumamed (Sumamed-Azythromycin, pliva) on the first day of treatment, 1 g, then in a daily dose of 500 mg, only 6 g per a course of treatment. The course dose of lycopide is 1 g. Starting from the first day of treatment, tincture of Eleutherococcus 15 drops 2 times a day and tocopherol acetate (vitamin E) 200 mg 2 times a day inside as an antioxidant is prescribed as an adaptogen.

Claims (1)

A method for the treatment of chronic chlamydial prostatitis that is resistant to standard therapy, comprising the integrated use of immunomodulating and antibacterial therapy, characterized in that the immunocommodator lycopid is used differentially, depending on the initial activity of cells of the neutrophilic-leukocyte-monocytic series; with increased activity in the lymphocytic row CD 25+> 16, CD71 +> 4, HLA-DR>30; in the monocytic series CD25 +> 30, CD71 +> 35, HLA-DR> 70, and in the neutrophilic series HCT> 28 and HCT ₃ > 38, lycopide is administered sublingually 10 mg daily in the morning before meals, in a course dose of 1 g with the use of antibiotics macrolide series in therapeutic doses; and with a decrease in activity in the lymphocytic series CD25 + <10, CD71 + <1, HLA-DR <19, in the monocytic series CD25 + <20, CD71 + <30, HLA-DR <60, and in the neutrophilic series HCT <17 and HCT ₃ <27 lycopidum is prescribed sublingually at 10 mg daily in the morning before meals, in a course dose of 1 g, and macrolide antibiotics in therapeutic doses are added from the 5th day of treatment with lycopide.

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