RU2376989C1 - Method of treating patients with sterility induced by anovulation at background of chronic and acute inflammation of small pelvis organs - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular to gynecology and concerns treatment of patients with sterility induced by anovulation at the background of chronic and acute inflammation of small pelvis organs. For this purpose mixture of the following composition is introduced paracervically: amoxicillin 1000 mg, clavulanic acid 200 mg, longidase 1500 U and Novocain in form of 0.5% solution - 8 ml. Preparation is introduced 1 time a day during 10 days. Additionally serotonin in dose 1.0 ml 2 times a day during 5 days is introduced.

EFFECT: method ensures normalisation of ovulation and menstrual cycle, increase of libido, elimination of premenstrual syndrome, algodismenoria, acne in short terms with possibility of treatment in the outpatient setting.

3 ex

Description

The invention relates to medicine, namely to gynecology, and can be used for the treatment of patients with chronic salpingoophoritis, polycystic ovary, inflammatory ovarian cysts, tubo-ovarian infertility, ovarian dysfunction, chronic and acute endometritis (including postpartum, post-abortion, postoperative), adhesive process pelvic, chronic cervicosis, cervical erosion.

There is a method of treating inflammatory diseases of the pelvic organs, which consists in administering an oral mixture of amoxicillin / clavunate 1 g 2 times a day and ofloxacin 400 mg 2 times a day. When combined with candidiasis, it is advisable to add 150 mg of flucanazole once or 7 days to 50 mg in the treatment regimen. The duration of therapy is 14 days. Parenteral treatment is carried out by the introduction of a mixture of amoxicillin / clavunate 1.2 mg intravenously (iv) jet, every 12 hours, and ofloxacin 200 mg 2 times a day iv drip (Yaglov V.V., Inflammatory diseases of the pelvic organs. -l "Gynecology", Volume 8, No. 4, 2006).

Known closest to the claimed method for the treatment of inflammatory diseases of the pelvis using amoxicillin 1.2 mg i.v. jet 2 times a day for 7 days and oflaxacin 400 mg i.v. drip 2 times a day for 7 days. In the process of treatment, cefazolin 1-2 g / v or cefurokim 1.5 mg / v in combination with metronidazal are used, an alternative drug is amoxicillin / clavunate 1.2 g / v. Antibacterial therapy is continued for up to 10 days according to two main schemes.

Scheme number 1. Amoxicillin 1.2 g and doxycycline or macrolides (erythromycin, clarithromycin or spiramycin) 500 mg 2 times a day.

Scheme number 2. Cefazolin 1-2 g 2 times a day, cefotaxime 1-2 g 2 times a day in combination with doxycycline 500 mg 2 times a day.

Scheme number 3. Ofloxocin 0.2 g 2 times a day in combination with metronidozole, ciprofloxacin in combination with tetracycline or erythromycin 500 mg 2 times a day. Lincomycin or clindamycin 300 mg 3 times a day and gentamicin 80 mg i / m 2 times a day. Tienam 1 g 2 times a day in combination with doxycycline 500 mg 2 times a day for 10 days (Tikhomirov A.L., Sarsania S.I. Amoxicillin / clavunate - an adequate approach to the treatment of inflammatory diseases of the female genital organs. J. Consilium medicum ”, Volume 08, No. 1, 2006).

Known methods have several disadvantages:

1 - repeated administration of antibiotics, at least 3 i / m and 2 i / v, which requires the patient to stay in the hospital;

2 - the need for large doses of the antibiotic, because parenteral antibiotics reach the pelvic organs no more than 3%;

3 - all of the above methods give a temporary effect, i.e. translate the acute inflammatory process into chronic;

4 - due to the fact that the inflammatory process takes place in the pelvic organs, the target organs - the ovaries inadequately respond to stimulation with various hormonal drugs, which, in turn, requires an increase in the doses of the latter. Thus, 90% of all patients suffering from this form of infertility undergo extracorporeal fertilization methods.

The objective of the invention is to provide a highly effective method of treating patients with infertility due to anovulation, against the background of an inflammatory disease of the pelvic organs, which allows to eliminate the chronic or acute inflammatory process of the pelvis and restore ovulation.

The problem is solved due to the fact that in the method of treating inflammatory diseases of the pelvic organs using an antibacterial agent, amoxicillin and clavulanic acid are used as an antibacterial agent, and the treatment is carried out by paracervical administration of a mixture of amoxicillin 1000 mg and clavulanic acid 200 mg, longidase 1500 IU and novocaine 8.0 ml of a 0.5% solution once a day for 10 days and intramuscular injection of serotonin 1.0 ml 2 times a day for 5 days.

Treatment is carried out using the following drugs:

Amoxiclav is a combined antibacterial and bactericidal agent from the group of semisynthetic penicillins ("protected penicillins"). It is a mixture of amoxicillin - a broad-spectrum bactericidal penicillin antibiotic and clavulanic acid, which has a progressive and irreversible inhibitory effect on the activity of beta-lactamases.

Longidase - a powder for the preparation of a solution for intramuscular or subcutaneous injection in ampoules or vials of 5 pcs. packaged. 1 vial (ampoule) of Longidase contains: a conjugate of hyaluronidase ( Lidase ) with an activated derivative of the N-oxide of poly-1,4-ethylene piperazine (an analog of polyoxidonium ) with a hyaluronidase activity of 1500 ME or 3000 ME. Longidase - an enzyme preparation; a drug with a wide spectrum of pharmacological action.

Serotonin is a solution for intravenous and intramuscular administration.

Hemostatic and anti-inflammatory agent.

Using the proposed method for the treatment of inflammatory diseases of the pelvic organs leads to a decrease in the size of the ovaries to normal, normalization of the menstrual cycle, elimination of all symptoms of the premenstrual syndrome, complete cure of algdismenorrhea, restoration of ovulation, increased libido, and elimination of the effects of acne.

This method allows for a short course to carry out anti-inflammatory and absorbable therapy. Reduces the dose of the drug administered in 2 times. The introduction of the drug is carried out 1 time per day, thereby eliminating the need for the patient to stay in the hospital.

Example 1

The patient is 32 years old. Diagnosis: Chronic endometritis, bilateral salpingo-oophoritis in the acute stage. Anovulation. Severe adhesion of the pelvis. Secondary infertility 5 years. From the anamnesis, one pregnancy, one birth, ended in cesarean section. Upon examination; pelvic organs are enlarged, sharply painful on palpation, appendages on both sides are soldered to the uterine rib. Ultrasound: the uterus is 59 mm × 46 mm × 52 mm, the ovaries 40 mm × 40 mm × 39 mm are enlarged, echogenicity is reduced, the follicular apparatus is not detected.

The treatment was carried out: Paracervical administration of a mixture of amoxiclav 1.2 g, longidase 1500 IU and novocaine 8.0 ml of a 0.5% solution for 10 days. At the same time, serotonin 1.0 ml is administered intramuscularly 2 times a day for 5 days. On re-examination: the uterus is not enlarged, palpation is painless. Appendages without features. Ultrasound of the pelvic organs: the uterus is 46 mm × 35 mm × 45 mm not enlarged, the contours are clear, the appendages are 32 mm × 30 mm × 30 mm to the right, left 30 mm × 28 mm × 32 mm, not enlarged, the follicular apparatus is visualized. After 1 menstrual cycle, without the use of hormones, pregnancy began. Births urgent, by cesarean section, full-term fetus weighing 3500 g, height 51 cm, gender - female., Healthy.

Example 2

The patient is 19 years old. Diagnosis: Chronic endometritis, bilateral salpingoophoritis. Anovulation. Algdisminorrhea. Primary infertility. Adhesive process of the pelvis. On examination: Expressed clinic of infantilism. The uterus is reduced in size. It is sharply painful on palpation, appendages on both sides are reduced in size, sharply painful on palpation, soldered to the ribs of the uterus. Ultrasound of the pelvic organs: uterus 22 mm × 30 mm × 22 mm, pronounced hypoechoic rim of the endometrium. Appendages are reduced in size 22 mm × 16 mm × 10 mm on the right, on the left 26 mm × 16 mm × 10 mm, the follicular apparatus is not visualized. The treatment was carried out: a mixture of amoxiclav 1.2 g, longidase 1500 IU and novocaine 8.0 ml of a 0.5% solution for 10 days is administered paraservically. At the same time, serotonin 1.0 ml is administered intramuscularly 2 times a day and for 5 days. Given the pronounced infantilism, a hormonal correction was performed. After one menstrual cycle, ovulation recovered. Pregnancy occurred on the third menstrual cycle, proceeding without complications. Childbirth live full-term fetus, male. Weight 3600, height 52 cm, healthy.

Example 3

The patient is 26 years old. From the anamnesis: one ectopic pregnancy, abdominal surgery, tubo- and ovariectomy on the right. Diagnosis: Chronic endometritis, left-sided salpingoophoritis. Hydrosalpinx on the left. Adhesive pelvic disease. Infertility is secondary. On examination: the uterus is enlarged, sharply painful on palpation. On the left, the appendages are enlarged, formation is determined in the area of the elongated tube, sharply painful on palpation. Ultrasound of the pelvic organs: the uterus is enlarged in size 52 mm × 46 mm × 58 mm the structure is heterogeneous. The appendages on the left are increased in size 40 mm × 39 mm × 42 mm, the pipe is enlarged, filled with uniform contents (liquid). The treatment was carried out: a mixture of amoxiclav 1.2 g, longidase 1,500 units and novocaine 8 ml of a 0.5% solution once a day for 10 days is administered paraservically. At the same time, serotonin 1.0 ml is administered intramuscularly 2 times a day for 5 days. After 8 menstrual cycles (the duration of the onset is due to one ovary) pregnancy occurred without the use of hormonal drugs, proceeded against the background of the threat of interruption. Ended in urgent delivery of a live full-term female fetus. Weight 3200 g, height 50 cm, healthy.

Claims (1)

A method of treating inflammatory diseases of the pelvic organs using an antibacterial agent, characterized in that amoxicillin and clavulanic acid are used as an antibacterial agent, and the treatment is carried out by paracervical administration of a mixture of amoxicillin 1000 mg and clavulanic acid 200 mg, longidase 1500 IU and novocaine 8.0 ml 0.5% solution once a day for 10 days and intramuscular injection of serotonin 1.0 ml 2 times a day for 5 days.