RU2414928C2 - Method of treating adolescents with pneumonia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to pediatrics, and concerns treating pneumonia in adolescents. For this purpose, a conventional integrated therapy is added with a non-microbial probiotic Actoflor-C containing synthetic analogues of low-molecular bacteria exometabolites of probiotic strains, which is introduced per os by 20 drops 3 times a day for 10 days.

EFFECT: method provides effective treatment ensured by enhanced immune response with no side dysbiotic effect of antibiotic therapy.

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Description

The invention relates to medicine, in particular to the field of pediatrics, and can be used to treat pneumonia in adolescents.

There is a method of treating pneumonia in children and adolescents (Tatochenko VK Pneumonia in children: etiology and treatment. - The attending physician, 2002. - No. 10. http://medi.ru/doc/1475053.htm).

However, despite the abundance of drugs, the treatment of pneumonia is not always successful, there are complications in the form of antibiotic-associated diarrhea, drug illness.

A known method for the prevention of respiratory infections and community-acquired pneumonia using microbial probiotics (Zhogolev S.D., Dobritsa V.P., Petrov L.N. et al. The use of probiotics for the prevention of respiratory infections and community-acquired pneumonia among military personnel // Bulletin of the Russian Military Medical Academy. - 2005. - No. 1 (13). - P.43-44).

The disadvantage of this method is the lack of data on its use as a treatment for pneumonia in children and adolescents.

The purpose of the invention is the expansion of the arsenal of therapeutic agents for treating pneumonia in adolescents, contributing to the preservation of microbiota.

The goal is achieved by the fact that, along with traditional methods of treatment (antibiotic therapy), the non-microbial probiotic Actoflor-C, 20 cap. 3 times a day for 10 days.

Actoflor-C is a synthetic analogue of low molecular weight exometabolites of bacteria of probiotic strains. The drug was developed by the Federal State Unitary Enterprise “State Research Institute for Highly Pure Biological Products” of the FMBA of Russia in 2006.

The method is implemented as follows. Adolescents aged 11-18 years old with a verified diagnosis of “Acute community-acquired pneumonia” along with conventional medication from the first days of hospitalization are prescribed inside the non-microbial probiotic Actoflor-S, containing synthetic analogues of low molecular weight exometabolites of bacteria of probiotic strains, 20 cap. 3 times a day for 10 days.

We give an example of the practical implementation of the proposed method of treatment.

Clinical example No. 1.

Mastepyan Andrey, 13 years old, was treated at Children's hospital No 1 in St. Petersburg from 11/21/06. until 12/01/06. (case history No. 15808) with a diagnosis of Acute community-acquired polysegmental pneumonia (S9, S10), uncomplicated, DN 1. Received complaints of coughing, shortness of breath, low-grade fever. Sick from 04.11.06, was treated on an outpatient basis with a diagnosis of acute respiratory infections, received symptomatic treatment, amoxiclav inside, positive dynamics were noted - catarrhal symptoms decreased, but 2 days after the end of taking the antibacterial drug, the temperature rose again to febrile numbers, in connection with which hospitalized. Upon admission to the hospital, a moderate condition, symptoms of intoxication, fever. Shortening of percussion sound in the lungs on the right in the lower parts along the posterior surface, breathing is weakened there, moist small-bubbling rales are heard. On the radiograph of the lungs on the right, infiltrative changes in S9, S10. In the clinical analysis of blood: White blood cells - 6.5 × 10 ⁹ / l (stab 1%, segmented 40%, eosinophils 7%, monocytes 5%, lymphocytes 47%), ESR 3 mm / hour. The treatment: claforam / m, 8 days; Actoflor inside of 20 drops 3 times a day for 8 days; inhalation with mucolytics, physiotherapy. To assess the effectiveness of therapy, studies were conducted: the level of secretory IgA in saliva (before and after the appointment of actoflora), an assessment of the state of intestinal microbiocenosis (before and after the appointment of actoflora). Against the background of the therapy, the patient's condition improved, hypertemic syndrome was stopped on the 2nd day, on the 8th day vesicular breathing without wheezing was determined in the lungs.

On the radiograph from 01.12.06 g - positive dynamics, there is no lung tissue infiltration.

The condition of the intestinal microbiocenosis of the patient during treatment improved:

1) the total number of Escherichia coli increased 100 times - from 10 ⁵ CFU / g to 10 ⁷ CFU / g;

2) the amount of typical Escherichia coli increased 100 times - from 10 ⁵ CFU / g to 10 ⁷ CFU / g;

3) the number of lactose-negative E. coli decreased by 10 times - from 10 ⁵ CFU / g to 10 ⁴ CFU / g;

4) the amount of hemolytic Escherichia coli decreased by 100,000 times - from 10 ⁵ CFU / g to 0 CFU / g;

5) the number of motionless E. coli decreased by 100,000 times - from 10 ⁵ CFU / g to 0 CFU / g.

The level of secretory IgA in saliva increased from 28,056 to 44.53 μg / ml.

Clinical example No. 2 using the traditional method of treating pneumonia shows less favorable results.

Kovalchuk Nastya 15 years old, was treated at Children's hospital No 1 in St. Petersburg from 10/14/07 to 10/27/07. (medical history No. 13989) with a diagnosis of Acute community-acquired right-sided polysegmental (S9, S10) pneumonia, uncomplicated, NAM 1. Complaints of fever, dry cough, shortness of breath during physical exertion. Sick from 10/05/07, I was disturbed by a dry cough, runny nose, fever to febrile numbers, received flemoxin, no effect was observed from the therapy, amoxiclav was prescribed from 12/10/07, symptoms of intoxication, fever persisted, and therefore was hospitalized. Upon receipt, a moderate condition, symptoms of intoxication. In the lungs, shortening of percussion sound on the right in the lower sections along the posterior surface, weakened breathing, moist finely bubbling rales in the same place. An X-ray revealed lung tissue infiltration in S9 and S10 of the right lung.

In a clinical blood test: White blood cells - 10 ⁸ × 10 ⁹ / l (stab 5%, segmented 64%, basophils 1%, eosinophils 3%, monocytes 10%, lymphocytes 17%), ESR 49 mm / hour. Treatment: claforan iv 8 days, gentamicin im 8 days, symptomatic, physiotherapy. The patient's condition improved during the therapy, the symptoms of intoxication, hyperthermia were stopped on the 5th day. Physical data improved by 9 days. On the control radiograph (13th day of treatment), moderate infiltrative changes on the right in S9 were noted.

In the dynamics of the state of the intestinal microbiocenosis of the patient, negative effects were noted during treatment:

1) the number of bifidobacteria decreased by 10 times - from 10 ⁸ CFU / g to 10 ⁷ CFU / g;

2) the number of bifidobacteria decreased by 1000 times - from 10 ⁸ CFU / g to 10 ⁵ CFU / g;

3) the total number of E. coli after treatment has not changed - 10 ⁵ CFU / g;

4) the amount of typical E. coli after treatment has not changed - 10 ⁵ CFU / g.

Positive changes in intestinal microbiocenosis resulted in the following:

1) the number of lactose-negative E. coli decreased from 10 ⁵ CFU / g to 0 CFU / g;

2) the amount of hemolytic Escherichia coli decreased from 10 ⁵ CFU / g to 0 CFU / g;

3) the number of motionless Escherichia coli decreased from 10 ⁵ CFU / g to 0 CFU / g.

The dynamics of the level of secretory IgA in saliva was negative:

before treatment, the values of secretory IgA were 478.27 μg / ml, after treatment - 465.12.

To prove the possibility of industrial applicability of the proposed method, a study was conducted of the results of treatment of pneumonia in adolescents in a hospital.

In the pediatric ward of Children's hospital No 1 in St. Petersburg, 24 patients from 11 to 18 years old were under observation with an X-ray verified diagnosis: "Acute community-acquired pneumonia." Patients were divided into 2 groups depending on the therapy: the experimental group (n = 13), along with antibacterial therapy, ingested the probiotic Actoflor-C, containing low molecular weight bacterial exometabolites, 20 drops each. 3 times a day for 10 days; the comparison group (n = 11) received antibiotic therapy for 10 days.

The effectiveness of the treatment regimens used in patients with pneumonia was evaluated on the basis of a study of the dynamics of microbiota indicators. In the observed patients, the state of intestinal microbiocenosis was 2 times evaluated by the bacteriological method, the content of secretory immunoglobulin A (SIgA) was studied before the start of therapy and after 10 days. The data obtained were processed statistically.

Table 1 presents data on the dynamics of the composition of fecal microflora in patients with pneumonia of the experimental group (using Actoflora) aged 11-18 years (n = 13) before and after treatment according to bacteriological analysis (average Lg CFU / g).

Table 2 presents the analysis of the dynamics of the composition of fecal microflora in patients with pneumonia of the comparison group aged 11-18 years (n = 11) before and after treatment according to bacteriological analysis (average Lg CFU / g).

Assessment of the dynamics of the colon microflora in patients of the experimental group showed a significant increase in titers of bifidobacteria (from 7.54 to 8.62 CFU / g), lactobacilli (from 7.38 to 8.31 CFU / g), typical E. coli (from 4 69 to 6, 54 CFU / g). In addition, there was a significant decrease in titers of defective (dysbiotic) E. coli - lactose-negative E. coli (from 4.08 to 3.38 CFU / g) and immobile (from 3.69 to 1.54 CFU / g). On the contrary, in patients of the comparison group, against the background of treatment with pneumonia with antibiotics, a significant decrease in the number of obligate intestinal flora was found, which protects against the expansion of pathogenic and conditionally pathogenic flora and the development of dysbiosis - a decrease in titers of bifidobacteria (from 8.91 to 8.36 CFU / g) and lactobacilli ( from 8.91 to 8 CFU / g).

The study of the state of local immunity showed a clear increase in the content of SIgA in saliva (M ± m) in patients of the experimental group during therapy from 286.6 ± 99.2 to 388.4 ± 111.7 μg / ml (p> 0.05), on the contrary, in patients of the control group, the SIgA content remained practically unchanged: 526.1 ± 15.7 μg / ml before treatment, 551 ± 34.7 μg / ml after treatment.

Thus, in adolescents with acute community-acquired pneumonia, against the background of standard antibiotic therapy, development of dysbiotic intestinal disorders in the form of significant inhibition of bifidobacteria and lactoflora is noted. Dysbiotic microbial associations do not contribute to the adequate implementation of the immune and nutritional functions of the intestine, which is manifested by the imperfection of rehabilitation of patients with pneumonia. The complex therapy of adolescents with pneumonia using the non-microbial (metabolite) probiotic Actoflor-S provides an adequate immunostimulating effect on the body and provides high-quality rehabilitation.

The advantage of the metabolite probiotic Actoflora-S over its analogue, a microbial probiotic based on symbiotic strains of lactobacilli Vitaflor, is the possibility of its use in patients with primary immunodeficiency, since the translation of microbes of the probiotic preparation into the internal environment of the body is excluded.

Table 1. Name of microorganisms Before treatment After treatment Bifidobacteria 7.54 8.62 * Lactobacilli 7.38 8.31 * Bacteroids 0 0 Clostridia 0 0 The total number of Escherichia coli 4.31 6.23 * Typical Escherichia coli 4.69 6.54 * Lactose-negative E. coli 4.08 3.38 * Hemolysing E. coli 3.31 2.46 Fixed Escherichia coli 3.69 1.54 * Proteus genus microbes 0 0.31 Klebsiella 1.15 0.31 Cytobacter 0 0.31 Pseudomonas 0 0 Other enterobacteria 0 0 Candida mushrooms 0.62 0.46 Staphylococcus aureus 0 0.31 Epidermal staphylococcus 0 0.31 Enterococci 0 0.31 Pathogenic flora 0 0.31 Note: * - statistically significant results (p <0.05) Table 2. Name of microorganisms Before treatment After treatment Bifidobacteria 8.91 8.36 * Lactobacilli 8.91 8* Bacteroids 0 0 Clostridia 0 0 The total number of Escherichia coli 5.09 5.09 Typical Escherichia coli 5.09 5.09 Lactose-negative E. coli 3.45 3 Hemolysing E. coli 3.18 2.27 Fixed Escherichia coli 2.73 1.36 Proteus genus microbes 0.45 0.45 Klebsiella 0 0 Cytobacter 0 0 Pseudomonas 0 0 Other enterobacteria 0 0 Candida mushrooms 0 0 Staphylococcus aureus 0 0 Epidermal staphylococcus 0 0 Enterococci 0 0 Pathogenic flora 0.09 0

Claims (1)

A method of treating sick teenagers with pneumonia using drugs, characterized in that they additionally prescribe the non-microbial probiotic Actoflor-C inside, containing synthetic analogues of low molecular weight exometabolites of bacteria of probiotic strains, 20 cap. 3 times a day for 10 days.