RU2203039C1 - Combined chemotherapeutic agent for treatment of trophic ulcer, topical wound infection and inflammatory disease - Google Patents

Abstract

FIELD: medicine, pharmacy. SUBSTANCE: invention relates to agent used for treatment of trophic ulcers, topical wound infections. Medicinal agent comprises chinosol, streptomycin, anhydrous lanolin and distilled water. Invention provides enhancement of treatment efficiency and reduction of period of patients in hospital. EFFECT: enhanced effectiveness of agent and treatment. 2 ex

Description

 The invention relates to medicine, in particular to means for the treatment of trophic ulcers, wound infections and inflammatory diseases.

 Trophic ulcers, eczema, neurodermatitis, venous bleeding often complicate the course of chronic venous insufficiency of the lower extremities. One of the most serious complications is trophic ulcers, which are found in 40-60% of patients with chronic venous insufficiency of the lower extremities. This complication often leads to persistent disability and disability.

 Treatment of vasotrophic ulcers is one of the most difficult and far from unresolved problems in surgery.

 The urgency of the problem is also due to the fact that a wound infection (including an infection sown from separable trophic ulcers) has a pronounced polymicrobial character, i.e. can be caused by many aerobic and anaerobic bacteria with different sensitivity to chemotherapeutic agents. However, any chemotherapeutic agent in the interests of harmlessness to somatic cells of the human body has a narrow spectrum of antimicrobial activity.

The closest in technical essence and the achieved result is the combined chemotherapeutic agent "Butol" for the treatment of wound infections and inflammatory diseases (RF patent 2115418, MKI 6 A 61 K 31/47, 31/71, published in IPM Bulletin 20, 07/20/1998 g), containing an antiseptic - chinosole, an antibiotic - streptomycin with a ratio of components, g:
Chinosol - 0.5
Streptomycin - 1.5
Distilled sterile water - Up to 1000.0
The use of the well-known Butola in patients with local infectious complications (burns, purulent wounds), in gynecological and cosmetological practice, showed its greater effectiveness (on average 2-3 times) compared with traditional treatment.

 However, the use of “Butol” in clinical practice, which is partly due to its form in the form of a solution, has revealed drawbacks. So, in the treatment of wound infections, in order to maintain a constant therapeutic concentration of Butol, daily applications of the remedy for the wound are necessary, which is practically achieved by constantly wetting the Butol dressings. This leads to increased consumption of antiseptics, to the inconvenience of using the product by patients, which consists in constant monitoring of the condition of the dressing.

 In those cases when the dressing with “Butol” dries and “sticks” to the wound, its separation from the latter (even after wetting with the solution) causes painful sensations in patients and trauma to the epithelium.

 The use of "Butol" in patients with trophic ulcers, characterized by a chronic long course, deeper local changes, showed the need to use an antiseptic with high penetrating ability in the tissue, which will prolong and deepen the effect of the drug.

 The technical result, the achievement of which the creation of this invention is directed, is to increase the effectiveness of the treatment of patients with trophic ulcers, local wound infection and inflammatory diseases of various organs, reducing their hospital stay by using combined antibacterial agents containing several chemically and physically compatible antiseptics, capable of combining mutually enhance activity and expand the spectrum of antimicrobial activity.

The technical result is achieved by the fact that the combined chemotherapeutic agent for the treatment of trophic ulcers, local wound infections and inflammatory diseases, containing chinosol - an antiseptic, streptomycin - an antibiotic, additionally contains anhydrous lanolin, in the following ratio, g:
Chinosol - 0.5
Streptomycin - 1.5
Anhydrous lanolin - 500.0
Sterile distilled water - 498.0
The method of obtaining the proposed tool "Butolol" is as follows.

 Chinosol powder 0.5 g and streptomycin powder 1.5 g are diluted in 58 ml of distilled sterile water. Then the resulting solution (60 ml) is mixed in parts with anhydrous lanolin 500.0 g and distilled water 440 ml, then emulsified and packaged in jars of the desired volume.

 The lanolin introduced into the composition of the drug (IA Muravyov. Drug Technology. - M., 1971, p. 461) is a mixture of esters of high molecular weight cyclic alcohols - cholesterols, fatty acids and free high molecular weight alcohols. Lanolin is perfectly absorbed by the skin, because its composition is close to the fat-like substances that cover the skin of a person. Not irritating to the skin and mucous membranes. Lanolin refers to lipophilic bases.

 In the process of treatment, the ointment is applied to the affected surface (burns, trophic ulcers, bedsores, long-healing wounds) with an even layer under the dressing. Dressings are done 1 time in 2 days, with severe contamination of the wound 1 time per day. Dressings are performed until the wound surface is completely cleansed.

 The proposed combined chemotherapeutic agent, which is named "Butolan", has a high antibacterial and anti-inflammatory activity, prolonged action (dressings are performed once every 2 days), stimulating regeneration, and high penetration into the tissue. Butolan is convenient for patients to use. None of the clinical cases revealed complications when using the proposed Butolan.

 We illustrate some clinical observations.

 Example 1. Patient T., 36 years old, medical history 12396/1345, was admitted to the hospital for treatment with a diagnosis of varicose veins in the pool of both saphenous veins, loose type, complicated form, decompensation stage. Chronic venous insufficiency III Art. Ulcer of the lower third of the right lower leg. On examination: both lower extremities are edematous (the diameter is segmentwise identical), the trunks of both saphenous veins are expanded at the tibia level, small venous network, hyperpigmentation. On the right lower leg in the lower third on the medial surface there is an ulcer of 6 x 4 cm with scalloped edges, covered with masses of fibrin, with purulent discharge, saped edges, a depth of about 3-4 mm. From the anamnesis, he was ill for about 2 years, during which he noted the presence of an ulcer on his lower leg. He was treated in a clinic at the place of residence, in a hospital - without a clear effect. Ultrasound of veins of the lower extremities revealed insufficiency of safeno-femoral anastomoses on both sides, expansion and insufficiency of valves of superficial veins at the level of the legs of both lower extremities, insufficiency of perforating veins of the Dodd group on the right. In microbiological culture from wounds, the growth of Pseudomonas aeruginosa and Staphilococcus aureus was revealed. Along with the traditional general treatment, Butolan was used locally. Already on the first day of treatment with the drug, the patient noted a decrease in pain in the ulcer, the dressing ceased to get wet by the wound discharge. On the 3rd day there was a decrease in swelling of the wound, a decrease in the number of fibrinous deposits in the ulcer. On day 10, the ulcer surface is clean, the wound surface is pink, juicy granulation is visible. In the microbiological culture of growth of Pseudomonas aeruginosa, Staphilococcus aureus - no. The size of the ulcer decreased on average by 3 mm from the edges, the depth of the wound - up to 2 mm. Complete ulcer epithelization was achieved on day 29 from the start of treatment. The patient is restored to work capacity. After 3 months, there are no signs of ulcer recurrence. It should be noted that previous treatment for this disease did not have an effect.

 Example 2. Patient S., 49 years old, medical history 10145/964, was admitted to hospital for treatment with a diagnosis of post-thrombophlebitic disease of both lower extremities, edematous-ulcerative form, stage of secondary changes, middle segment. Chronic venous insufficiency III Art. Circular extensive ulcers of both legs. From the anamnesis, she suffered acute ileo-femoral thrombosis of both lower extremities about 6 years ago. He annually conducts courses of conservative treatment in a hospital and polyclinic at the place of residence, but does not notice a clear effect. With regard to venous disease has a disability of group II. On examination: both lower extremities are edematous, inductive cellulite, hyperpigmentation, no dilated vein trunks. On both legs, over their entire length, deep circular (up to 5 mm) with callous edges, extensive ulcers covered with a thick (up to 1 mm) layer of fibrin, with purulent fetid discharge. Ultrasound veins of the lower extremities revealed signs of deep vein obstruction at the level of the lower leg and lower third of the thigh on both sides, moderate expansion and failure of the superficial vein valves. An abundant growth of Pseudomonas aeruginosa, Escherichia coli, Proteus vulgaris was revealed in microbiological culture from wounds. Along with the traditional general treatment, Butolan was used locally. On the second day of treatment with the drug, the patient noted a decrease in pain in ulcers, soaking the dressings with purulent discharge decreased. By 10 days, pain does not bother, the dressings are dry, there is no smell from the wound. In the sowing of the wound discharge - single colonies of Ps. aeruginosa. The amount of fibrin has noticeably decreased, on the left lower leg there is a site of marginal epithelization of 2 x 6 cm. On day 20, the wounds completely cleared of fibrin, without inflammation, are clean. In crops - single colonies of epidermal staphylococcus. On the left tibia, a 4 x 8 cm area is covered with a newly formed epithelium, epithelization from the edges of 3-4 mm is noted on the right. On day 25, epithelization of an ulcer of the left tibia 8 mm from the edges, on the right - 6 mm. Given the positive dynamics, the patient was discharged. At home, the patient continued to conduct independent dressings with the indicated agent. The patient was examined on day 45 from the start of treatment. The ulcer on the left lower leg is completely covered with epithelium, dry, clean. On the right was a section of the wound surface 9 x 4 cm, clean, pink. On day 53 from the start of treatment - complete epithelialization of ulcers. The patient returned to normal daily life, domestic work. After 3 months, there are no signs of ulcer recurrence. I would like to note that previous treatment for this patient did not have an effect.

 In patients with a milder course of diseases for this pathology, the therapeutic effect of the use of the combination agent we proposed turned out to be 2.5-3 times higher on average compared to traditional local treatment, which indicates its high efficiency.

 A search by the applicant for scientific, technical and patent sources of information on the fund of the patent and technical department of the Samara Regional Technical Library and analysis of the prior art, identifying sources containing information about the closest analogue of the claimed invention, made it possible to establish that no signs characterized by identical signs were found ( identical) to all the essential features of the claimed invention "Combined chemotherapeutic agent for the treatment of trophic ulcers, local wounds howling infections and inflammatory diseases. "

 Therefore, the claimed invention meets the criterion of "novelty."

 To verify the compliance of the claimed invention with the condition "inventive step", the applicant conducted an additional search for known solutions to identify signs that match the distinctive essential features of the claimed invention.

 The search results showed that the claimed invention "Combined chemotherapeutic agent for the treatment of trophic ulcers, local wound infections and inflammatory diseases" does not follow explicitly from the prior art, as determined by the applicant, the effect of the envisaged essential features of the claimed invention on the achievement of the set technical result was not revealed.

 Therefore, the claimed invention meets the criterion of "inventive step".

 The criteria of the invention "industrial applicability" is confirmed by the fact that the proposed invention "Combined chemotherapeutic agent for the treatment of trophic ulcers, local wound infections and inflammatory diseases" can be successfully and efficiently, without significant material costs, used in various areas of clinical practice for the treatment of purulent wounds, local wound infection and inflammatory diseases.

Claims (1)

A drug for the treatment of trophic ulcers, local wound infection, characterized in that it contains quinosol, streptomycin, distilled sterile water, anhydrous lanolin with the following components, g:
Chinosol - 0.5
Streptomycin - 1.5
Anhydrous lanolin - 500.0
Sterile distilled water - 498.0d