RU2549485C2 - Method of treating pulmonary tuberculosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to phthisiology, and can be used in treating pulmonary tuberculosis accompanied by tuberculosis intoxication. To this effect, administering anti-tuberculosis preparations is combined with the additional intravenous drop-by-drop administration of Reamberin, Heptral and antitoxic polyvalent antigangrenous serum (AGS) preceded by the administration of heparin 50 units/kg; Reamberin is administered in an amount of 400 ml on the first and second day for 2 hours; Heptral is introduced in an amount of 400 ml from the first to the fifth day; AGS is administered on the third day in an amount of 30 thousand International Units, on the fourth day in an amount of 60 thousand International Units, in case of a destructive process - in an amount of 60 thousand International Units on the fifth day; AGS is administered in normal saline NaCl 400 ml, and the first 1 ml of the solution is administered for 5 minutes, the rest amount - for 1.5-2 hours.

EFFECT: method enables increasing the clinical effectiveness of pulmonary tuberculosis as soon as possible by binding and neutralising microbial exo- and endotoxins by serum antibodies with no side effects and reduced financial expenses.

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Description

The invention relates to medicine, namely to phthisiology.

Despite the use of the most effective antibiotics and modern technologies, mortality from tuberculosis remains high. The growth of genetically mutated bacteria makes us look for a bacteria-friendly strategy for fighting bacteria. A known method of treating pulmonary tuberculosis, which is the use of a combination of antibiotics with pentaglobulin.

Pentaglobulin - a human immunoglobulin, intravenous administration, neutralizes the endotoxin of microbes in bacterial infections. Dosage 5 ml / kg body weight, the drug is administered for 3 days.

The disadvantages of the prototype include the fact that it is unstable to the action of bacterial proteases; it cannot be administered in case of impaired renal function, cases of aseptic meningitis after administration of pentaglobulin are described.

The aim of the invention is to increase the effectiveness of the treatment of pulmonary tuberculosis.

The essence of the proposed method as an invention is as follows: patients with tubing intoxication, regardless of the stage of infection, are injected intravenously, drip, antitoxic, polyvalent, anti-gangrenous serum - ASG. Dosage schedule: for 400 ml of isotonic NaCl solution, antitoxic, polyvalent, anti-gangrenous serum is administered - 1 dose (30 thousand international units). The first 1.0 ml of the resulting solution is injected within 5 minutes as a sample for the reaction of the body, the remaining volume within 1.5-2 hours (the instruction is approved by the beginning of the Ch. Exercise of the USSR Ministry of Health, 1988).

The main mechanism of action of antitoxic polyvalent antigangrenous serum (ASG) is the binding and neutralization of exo- and endotoxins of microbes by antibodies contained in serum.

Example No. 1 of a specific implementation of the method.

Ziyavudinov G-Murad, born in 1979, RD, Makhachkala, 59/29 Kirova Ave. For the first time he turned to a phthisiatrician on 12/25/09 with complaints: irritability, insomnia, sweating, prolonged, more than 1 month, subfebrile condition. In blood tests - moderate leukocytosis, lymphocytosis, accelerated ESR. In the urine - white blood cells, traces of protein.

On the R-gram from 12/25/09, there are infiltrative foci of the upper lobe of the right lung. For 420 days (12/25/09/06/01/12) he took anti-TB drugs: isoniazid 900 mg per day, in combination with rifampicin, 750 mg × 2 times a day, for 180 days. Capriomycin - 1 g once a day, for 120 days. Phtivazide 1 g × 2 p. per day, for 120 days. On the R-gr. lungs No. 1879 from 06/17/10, on CT-lungs from 01/06/10, infiltrative foci in the upper lobe of the right lung.

05/01/12, at the same time introduced 60 thousand ME (2 doses) ASG according to the scheme. On the R-gr. from 05/31/12, chest organs - calcified focal shadows in the upper lobe of the right lung. The roots are structural. Pulmonary pattern enhanced. Sinuses are free. Heart without features. Consultation of a TB specialist is recommended. Removed from the register. Is healthy.

Example No. 2.

Musaeva Elmira, born 1986 RD, Makhachkala, Ave. Peter-I, building 53, apt. 58 (parental leave) November 29, 2011, due to the severity of the condition, was hospitalized in a hospital with DS: Infiltrative pulmonary Tbc, in the decay phase. Toxicity. DN II Art.

From 11/29/11 to 06/18/12, she was treated in a hospital for 215 days. On CT of lungs dated 04.25.12, No. 6854, multiple large foci are identified in the upper lobes of the lungs and in the lower lobe of the left lung, merging in places with the formation of irregular and round infiltrates, some of which are subpleural. In the part of infiltrates, small decay cavities are visible. Small focal infiltration in both lungs is visible. Conclusion: CT signs of hematogenously disseminated tbc lungs. On the R-gr. lungs No. 1836 of 06/15/12 - subpleural left rounded formation: 5 × 4.5 cm. Complaints of sleep disturbance, weakness, dry mouth, and itchy skin.

07/15/12, introduced, at the same time, 2 doses of ASG. July 16, 12, 2 doses of ASG, against the background of preliminary administration of heparin.

08/14/12 - tomogram number 1886. The cavity section is reduced in volume. The contours are deformed, peripheral infiltration is practically not traced, the fibrous cord is reduced. Consulted by a phthisiosurgeon. The dynamics are positive. The state of health is satisfactory. Conclusion: to refrain from surgical treatment.

On CT 05.16.13, No. 12254 - in the upper lobe of the right lung, in the upper and lower lobes of the left lung, areas of severe deformation of the pulmonary stroma, compaction of pulmonary interstitium, traction bronchiectasis, multiple dense foci are determined. Against the background of these changes, in the upper lobe, a rounded dense formation with clear contours, with a diameter of 18 mm, is determined. The lumen of the large bronchi is not deformed. Lymph nodes of the mediastinum are not enlarged. The vascular structures of the mediastinum without features, fluid in the pleural cavities is not detected. Conclusion: CT signs of fibro-focal changes in the lungs.

Example No. 3

Musaev Shamil, born 1982 RD, Makhachkala, Peter-I Ave., building 53 apt. 58, driver of a private enterprise. Musaeva’s spouse E. Extremely irritable. He refused from examination and treatment.

10/02/12, - 1 dose of ASG was administered intravenously drip: 03/10/12, 2 days of ASG. (according to the scheme).

On CT - from 10.29.12, compared (from 05.09.12) + dynamics. Conclusion - a picture of the infiltrative special process at the level of 1-2 segments of the right lung in the resorption phase.

02.21.13, on the R-gram of the chest organs, the lungs are determined without fresh foci or infiltrative changes. Single calcine in the upper lobe of the left lung. Heart without features. 02.21.13, deregistered.

The advantage of the proposed method is as follows:

1. antibodies contained in ASG do not cleave under the influence of bacterial proteases;

2. the absence of contraindications for administration and complications, with the introduction.

In our practice, in all patients who were injected with antitoxic polyvalent antigangrenous serum, positive dynamics were observed in the coming days: they felt better, their sleep and temperature returned to normal. Peripheral and venous blood indices improved (Tables 1, 2, 3, 4).

The proposed method for the treatment of pulmonary tuberculosis allows you to:

1. To achieve positive results, for the shortest possible time, in the absence of side effects and any contraindications, for the use of antitoxic serum. ASG.

2. Minimize the risk of drug-resistant bacteria strains.

3. Reduce the treatment time for patients.

4. Solve the problem of social rehabilitation of the patient.

5. Reduce the financial costs of treatment.

Information sources

1. Pentaglobin BIOTEST PHARMA Gmbh, Germany - prototype.

2. METHOD FOR TREATING PNEUMONIA IN DEEP-BORNING CHILDREN ON THE ARTIFICIAL LUNG VENTILATION, (RU) patent 2191031.

3. METHOD FOR TREATING LUNG TUBERCULOSIS, (RU) patent 2357745.

4. Pentaglobin (Pentaglobin®): instructions for use, contraindications and composition - Register of medicines - radar.

5. Anti-gangrenous polyvalent horse serum purified concentrated, liquid form of release: injection for 30 thousand ME, amp. 1 dose (1) complete with horse serum diluted 1: 100, amp. 1 ml (1) Manufacturer: FSUE NPO Microgen.

6. Serum antigangrenous polyvalent equine purified liquid concentrated (Serum antigangrenosum polyvalentum purificatum concentratum equinum fluidum): instructions for use, contraindications and composition - radar.

Table number 1 The scheme of the proposed method of treatment, depending on the severity of the process Name of the drug, route of administration, for how long 1st day
Dose 2nd day
Dose 3rd day
Dose 4th day
Dose 5th day
Dose 1. 1.5 Reamberin iv, drip for 2 hours 400 ml 400 ml 2. Intravenous heparin in a dose of 50 units / kg at a time, before the introduction of ASG Heparin Heparin Heparin 3. Antitoxic serum PGS in / in a drop, within 2 hours 1 day - 30 thousand ME per 400 ml. physical solution 60 thousand IU - 2d per 400.0 ml of physical solution 60 thousand ME per 400.0 ml of physical solution (with a destructive process) 4. Heptral, iv 400 mg 400 mg 400 mg 400 mg 400 mg

Table number 2 Specific example Full name Age DS Terms of treatment. Outpatient. R-study data and lung CT Date of administration and dose of ATC-ASG R-study data and lung CT after modified treatment DS TB specialist Ziyavudinov G-Murad, born in 1979 RD, Makhachkala, Kirova Ave. 59 “a”, apt. 25 Infiltrative tuberculosis of the upper lobe of the right lung 12/25/09 06/01/12 A / b - therapy for 420 days CT of the lungs dated January 6, 2010. According to the sum of CT, the infiltrative tbc of the upper lobe of the right lung is R-gr. lungs No. 1879 from 06/17/10 and from 12/25/09: infiltrative foci of the upper lobe of the right lung 05/01/12, 2 days - 60 thousand ME at a time R-examination of organs gr. cells from 05/31/12: calcified focal shadows in the upper lobe of the right lung. The roots are structural. Pulmonary pattern enhanced. Sinuses are free. Heart without features Is healthy.
Removed from the register

Table number 3 Specific example Full name age DS outpatient Inpatient number of days R-study data and lung CT Date of administration and dose of ATC-ASG R-study data and lung CT after modified treatment DS Phthisiosurgeon Musaeva Elmira, born 1986 RD, city M-kala, pr. Peter-I, 53 "c" / 58 Infiltrative tbc lung decomposition. DN II Art. 11.29.11 -18.06.12. city of Izberg. City Hospital 215 CT-lungs dated 04.25.12 No. 6854, R-gr. dated 06/15/12 No. 1836: in the upper lobes of the lungs and in the n / lobe of the left lung, multiple large foci of irregular and round shape, some of which are subpleural. In terms of infiltrates of the decay cavity. Conclusion: signs of hematogenously-desaturated tbc lungs. On the R-gr. lungs from 06/15/12, left rounded formation 5 * 4.5 in size, subpleural 07/15/12, 2 doses, 2 doses, 07/16/12 R-study from 08/14/12 linear tomogram No. 1886. The cavity section is reduced in diameter, the contours are deformed, almost no peripheral infiltration is observed, and the fibrous cord is reduced. CT No. 12254 of 05.16.13, + dynamics.

Table number 4 A specific example of the use of ASG is in the treatment of pulmonary tuberculosis, without a preliminary AV guarantee Full name age DS Terms of treatment R-study data and lung CT Date of administration and dose of ATC-ASG R-study data and lung CT after modified treatment DS Phthisis Atra Musaev Shamil born in 1982 RD, Makhachkala, Petra-1, 53, apt. 58
Refused therapy.
Spouse of Musaeva Elmira 3 doses 02.10.12, 1 dose 03.10.12, 2 doses R-studies of 02.21.13, No. 30. Lungs without focal or infiltrative changes.
Single calcine of the upper lobe of the left lung. CT-10.29.12. The picture of the infectious special process at the level of 1-2 segments of the right lung in the resorption phase Is healthy

Claims (1)

A method for the treatment of pulmonary tuberculosis in patients with toxicosis, including the introduction of anti-TB drugs, characterized in that additionally intravenous drip of reamberin, heptral and antitoxic polyvalent antigangrenous serum (CBC) with preliminary administration of 50 units / kg of heparin, while reamberin is administered 400 ml per 1st and 2nd day for 2 hours; heptral 400 mg from the 1st to the 5th day; ASG on the 3rd day 30 thousand IU, on the 4th day 60 thousand IU, and in the case of a destructive process - 60 thousand IU on the 5th day, moreover, ASG is administered per 400 ml of isotonic NaCl solution and the first 1 ml of solution is administered for 5 minutes, the rest is within 1.5-2 hours.