RU2392931C1 - Method of treating bacterial urethritis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to urology, and concerns treating bacterial urethritis in males. That is ensured by introduction into posterior and anterior urethra of 5 ml of a mixture containing 50 ml of 25% Dimexid and 5 g of Fucitalmic gel. The exposition is 3 minutes. Introduction is carried out once a day. The therapeutic course is 5 days.

EFFECT: due to specified composition of the mixture and introduction mode, the method makes it possible to treat urethritis conditioned by various microflorae without by-effects.

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Description

The invention relates to medicine, namely to dermatovenerology, and can be used for the treatment of bacterial urethritis in men due to staphylococcus and streptococci.

Bacterial urethritis is a common independent disease that is part of the group of "non-gonococcal urethritis." According to the international statistical classification of diseases and health problems X revision, bacterial urethritis is under the code N34.1.

The problem of bacterial urethritis is actively discussed by doctors of various specialties: urologists, dermatovenerologists, microbiologists, etc. (1). Especially controversial are the judgments about the etiological role of various microorganisms in the occurrence of inflammatory lesions of the genitourinary system.

Knowledge of the composition of the microbial flora of the urethra is normally necessary in order to correctly assess the results of bacteriological and microscopic studies of the urethral discharge, since it is very difficult, and sometimes impossible to accurately determine the degree of participation of each microorganism in the inflammatory process.

It is believed that, on the one hand, opportunistic microorganisms are representatives of the normal microflora of the reproductive system and, preventing the pathogens from settling, provide colonization resistance to the ecological niche. On the other hand, acquiring aggressive potencies, they can be an etiological factor in the inflammatory process in the genitals (2).

Not all bacteria isolated from the urethra are causative agents of urethritis. Bacteria can be either commensals or satellites of inflammation caused by other agents. Microorganisms isolated in culture can be recognized as pathogens of urethritis only when they belong to highly pathogenic bacteria - pathogens of common infections or belong to species not normally found on the mucous membrane of the genitals of healthy people (2).

Bacterial diseases of the genitourinary system can be caused by microorganisms, which are usually present in the microbial flora of the lower genital tract or get into them from the outside, or during sexual intercourse or other circumstances that change the composition of the urethral microflora in favor of more virulent microorganisms. Various microorganisms can be such: β-hemolytic streptococci, staphylococci, enterobacteria, coryneform bacteria, pseudomonads, gardnerella (2).

Many authors have noted that streptococci, staphylococci, enterobacteria and other microorganisms that live on the surface of the body can penetrate tissues only when the mucous membrane of the skin is damaged (inflammatory processes, foreign bodies, trauma to the mucous membrane during instrumental examinations and local therapeutic procedures, taking material for laboratory research). They can also enter the urogenital organs simultaneously with gonococci, chlamydia, viruses during sexual intercourse (1).

Direct contact of a man’s penis with a woman’s anal opening creates a risk of infection for both partners. Anal and orogenital sexual intercourse can also cause infection, since streptococci, staphylococci, neisseria and enterobacteria are often found in the pharynx.

It is also possible hematogenous or urogenic penetration of pathogens into the genitals from foci of latent infection (from the kidneys, nasopharynx). Trichomonads can serve as a vehicle for microorganisms when they enter the upper parts of the genital organs.

As for the frequency of detection of various types of bacteria, the information of various authors about the normal microbial landscape is rather contradictory. So, W. Schmidt (3) when examining 158 healthy men received the following data: aerobic bacteria (Staphylococcus epidermidis 88%, Staphyloccus aureus 1.5%, Diphtheroide 69%, Staphylococcus group 3%, Staphylococcus faecalis 7%, Klebsiella pneumoniae 1 , 5%, Neisseria catarrhalis 3%, E. coli 4%, Acinetobacter spp. 3%, Gardnerella vaginalis 37%, Lactobacillus spp. 6%), unidentified saprophytic strains 39%, anaerobic bacteria (Propionibacterium sp. 15%, Bifidobact 3%, Peptococcus spp. 7.5%, Peptostreptococcus spp. 4.5%).

When studying the urethral microflora in 18 healthy men, O.V. Bukharin (4) found that gram-positive microorganisms, which were represented by coagulase-negative staphylococci, non-hemolytic streptococci, lactobacilli and coryneform microorganisms (Staphylococcus%), were found at different frequencies in the anterior part of the urethra , Staphylococcus haemolyticus 50%, Staphylococcus saprophyticus 44.4%, Staphylococcus capitis 38.9%, Staphylococcus hominis 44.4%, C.genitalium 100%, C. pseudogenitalium 16.6%, Lactobacillus spp. 100%, Streptococcus spp. 66.7%).

Almost all authors sowed white non-hemolytic staphylococci (Staphylococcus epidermidis) from the urethra of healthy men. It is believed that this type of staphylococcus, usually localized in the front of the urethra, while not being pathogenic, is involved in the antimicrobial protection of the mucous membrane, releasing substances that inhibit the growth of pathogenic microorganisms. Thus, we can assume that the normal bacterial landscape of the urethra is saprophytes: non-pathogenic staphylococci, diphtheroids, streptococci and some undifferentiated gram-positive diplococci and bacilli, as well as apatogenic anaerobes: Peptococcus, Peptostreptococcus, Bacteroides, etc. 3.

Initially, most urethritis is accompanied by damage to the front of the urethra. However, quite often with prolonged urethritis, inflammation is not limited to the front, but spreads to the back of the urethra and total urethritis occurs, which usually proceeds torpid with periodic exacerbations, often accompanied by focal changes in the urethra (littreitis, morganite, colliculitis, etc. ) and the development of complications (prostatitis, etc.).

In practice, antibacterial drugs of various groups are used to treat bacterial urethritis. Among the factors affecting the state of intestinal microcenosis, one of the first places is occupied by the irrational use of medicines, including antibacterial drugs (5).

A.N. Bonev (6 - prototype) in the treatment of bacterial urethritis in 23 patients used Ekmolin (0.5% triprotamine sulfate solution) as a local treatment. This solution was administered to the patient after urination in the front section of the urethra in a volume of 10 ml, which was delayed for 1 min by pinching the urethra with fingers. These manipulations were carried out once a day for 5 days.

Treatment with this method gave very good results. After the first instillations, subjective dysuric symptoms disappeared, and at the end of the course in 82.6% of patients, the clinical manifestations of urethritis completely disappeared or very poor transparent discharge without leukocyte content remained. All patients underwent the procedures well, but the effectiveness of therapy is not high enough.

The technical result of the invention is to increase the efficiency and safety of treating bacterial urethritis in men by obtaining faster elimination of the pathogen from the urethra and a pronounced anti-inflammatory effect.

The technical result is achieved by the fact that in the method of treating bacterial urethritis, as a antibiotic, a mixture of 50 ml of a 25% Dimexidum solution and 5 g of Fucitalmic gel is used, introduced into the posterior and anterior parts of the urethra, 5.0 ml each, with an exposure time of 3 minutes.

The essence of the invention lies in the use for the first time for topical treatment of bacterial urethritis in men caused by staphylococci and streptococci, Fucitalmic gel in combination with Dimexide. Gel Futsitalmik has a pronounced bactericidal effect and it is for such microorganisms as strepto and staphylococci, as follows from the annotation to the drug.

The combination of 50 ml of a 25% solution of Dimexidum and 5 g of Futsitalmic gel provides the fastest eradication of the pathogen due to a better and faster deposition on the mucous membrane of the urethra in the absence of side effects, which leads to a faster and more pronounced anti-inflammatory effect.

Treatment with instillations of 5 ml into the posterior and anterior urethra of this mixture with an exposure of 3 min showed Fucitalmic highly effective. After the instillations in patients, subjective symptoms disappeared on the 2-3rd day, and at the end of the course of treatment in 95.5% of patients, the clinical manifestations of urethritis completely disappeared. The authors noted good tolerability of the procedures in all patients. During the control microscopic examination of the discharge from the urethra, the number of leukocytes did not exceed 3-4 in the field of view, and during microbiological examination, the complete elimination of the etiological factor of inflammation was noted.

From the analysis of scientific, technical and patent literature, the claimed combination of features, which can significantly improve the effectiveness and safety of treatment of urethritis caused by strepto- and staphylococcal microflora, has not been identified, which allows us to conclude that the claimed technical solution meets the criteria of "novelty" and "inventive step".

The invention is implemented as follows: patients with bacterial urethritis are instilled with a mixture consisting of 50 ml of 25% Dimexidum and 5 g of Futsitalmik gel. A mixture of 5.0 ml is injected into the posterior and anterior parts of the urethra with an exposure of 3 minutes and a frequency of procedures of 1 daily. The course of therapy is 5 instillations.

The authors studied the urethral discharge of 156 men who applied to the clinic of the Federal State Institution UrNIIDViI of Rosmedtekhnologii with complaints from the urogenital tract (periodic plaque on the glans penis, pain, burning, slight mucous or mucopurulent discharge from the urethra, dysuria, feeling of discomfort in the canal) perineal region). The age of patients is from 18 to 56 years. Sexually transmitted diseases: chlamydia, gonorrhea, trichomoniasis, mycoplasma and ureaplasma infections were excluded.

In the bacteriological laboratory, the species composition and the degree of contamination of the urethra by microorganisms were studied. Sowing was carried out on plate culture media: 5% blood-yeast agar. Identification of the isolated microorganisms was carried out according to the definition of the Bergei bacteria. Positive results were taken into account with a titer of 10 ⁴ degrees and above.

The following results were obtained: gram-negative bacteria such as E. coli were found in 63 (40.4%) patients, Proteus vulgaris - 18 (11.5%), Klebsiella pneumoniae - 12 (7.7%), Enterobacter spp. - 10 (6.4%) patients. Of the gram-positive microorganisms, Streptococcus agalactiae was most often seeded in 46 (29.5%) and Staphylococcus aureus in 35 (22.4%) patients. And such an optional anaerobic as Gardnerella vaginalis was detected in 77 (49.4%) of the examined men.

It was found that the studies showed a significant prevalence of pathogens such as Gardnerella vaginalis, E. coli, Streptococcus agalactiae, Staphylococcus aureus and Proteus vulgaris, found in bacterial urethritis in men. Moreover, the inflammatory process in the urethra caused by streptococcal and staphylococci was detected in the largest number of cases - in 82 (52.6%) patients. The revealed high percentage of the inflammatory process in the urethra, caused by strepto- and staphylococci, served to develop a new highly effective method of local treatment.

The use of this treatment method is illustrated by the following examples.

Example 1

Patient N., 23 years old. Diagnosis: Bacterial urethritis caused by Staphylococcus aureus, subacute course. During the examination, the patient complained of mucopurulent discharge from the canal, minor pain during urination for 7 days. Objectively: the lips of the urethra are slightly hyperemic, swollen, with a massage of the urethra from the urethra, slight mucopurulent discharge was observed. The patient underwent 5 instillations - 1 daily. A mixture of 50 ml of a 25% solution of Dimexidum and 5 g of Futsitalmik gel was injected 5 ml into the posterior and anterior parts of the urethra with an exposure of 3 minutes. The course of treatment was 5 instillations. A control study was carried out on the 6th day after the end of therapy. In bacteriological cultures from the urethra, Staphylococcus aureus was no longer sown, while the objective symptoms - hyperemia of the urethral sponges, swelling and discharge from the canal disappeared.

Example 2

Patient P., 28 years old. Diagnosis: Bacterial urethritis due to Streptococcus agalactiae, acute course. During the examination, the patient complained of burning and pain during urination, redness of the lips of the urethra and purulent discharge from the channel for 10 days. Objectively: the lips of the urethra are sharply hyperemic, swollen, with a massage of the urethra from the canal, abundant purulent discharge was observed. In bacteriological cultures, Streptococcus agalactiae, abundant growth, was sown from the urethra. The patient underwent 5 instillations into the urethra (one daily) of a mixture of 50 ml of a 25% solution of Dimexidum and 5 g of Futsitalmik gel. A mixture of 5 ml was injected into the posterior and anterior parts of the urethra with an exposure of 3 minutes. A control study was carried out on the 6th day after the end of therapy. In bacteriological cultures from the urethra Streptococcus agalactiae was no longer sown, while the objective symptoms - hyperemia of the urethral sponges, swelling and discharge from the canal disappeared.

In this way, 45 patients with bacterial urethritis were treated. Examples of treatment are similar to those given above. The data are given in the table.

Table Options Ecmoline (0.5% triprotamine sulfate solution) (prototype) A solution of 0.25% Dimexidum and 1 g of Futsitalmik gel (the claimed method) Number of patients 23 45 Number of installations 5 5 Efficiency 82.6% 95.5%

As can be seen from the table, the effectiveness of the therapy was 95.5%.

Thus, the obtained results indicate that the proposed method for the treatment of bacterial urethritis in men has a pronounced etiological and clinical efficacy. The simplicity of the treatment technique, cost-effectiveness, the absence of common (impaired intestinal microbiocinosis) and local side effects with high therapeutic efficacy allow us to recommend this method for the treatment of bacterial urethritis due to streptococcal and staphylococcal nature.

Bibliography

1. Mavrov I.I. Sexual diseases / I.I.Mavrov. - M .: Ast-press book, 2002.752 p.

2. Molochkov V.A. Chronic urethrogenic prostatitis / V.A. Molochkov, I.I. Ilyin - M .: Medicine, 1998. - 273 p.

3. Schmidt W. Spectrum of pathogens in non-gonococcal urethritis / W. Schmidt, M. Hartman // Bulletin of Dermatology and Venereology. - 1988. - No. 10. - S. 32-34.

4. Bukharin OV Characterization of changes in microbiocinosis in patients with chronic nonspecific urethritis / O.V. Bukharin // Zh. microbiol. - 2001. - No. 4. - S.86-89.

5. Vorobyov A.A., Abramov N.A., Bondarenko V.M., Shenderov B.A. Dysbacteriosis and eubiotics. Abstracts All-Russian scientific and practical conference dedicated to the 100th anniversary of the Moscow Scientific Research Institute of Electrical Engineering G.N.Gabrichevsky. M., 1996; 42.

6. Bonev A. A new method of local treatment of non-gonococcal urethritis / A. Bonev // Vestn. Dermatology and Venereology, 1978, No. 7, p. 46-47.

Claims (1)

A method of treating bacterial urethritis by local injection of an antibiotic into the urethra once a day for 5 days, characterized in that a mixture of 50 ml of a 25% solution of Dimexidum and 5 g of Futsitalmik gel, administered 5 ml in the back and anterior urethra with an exposure of 3 min.