RU2602692C1 - Method of treating chronic pharyngitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine and aims at treating chronic pharyngitis. Autovaccine is grown by sowing smear from mucous membrane orifice on nutrient medium. Then extraction of pure cultures of disease activators is made: Str. haemoliticus-β, or St. aureus, or Klebsiella pneumoniae. Immunomodulatory agent is prepared consisting of 2 wt% of autovaccine (1,000,000 microbial particles/ml), 0.003-0.005 wt% of polyoxidonium, 2 wt% of 0.9 % aqueous solution of sodium chloride. Obtained agent is used in form of intranasal instillations of 1 ml into each nostril × 2 times a day after meals, duration os 7-10 days.

EFFECT: method provides higher treatment effectiveness.

1 cl, 2 tbl, 3 ex

Description

The invention relates to medicine, in particular to otorhinolaryngology, and can be used in the treatment of chronic pharyngitis.

The treatment of chronic pharyngitis is one of the urgent problems of modern medicine due to the high prevalence of pharyngeal inflammation in various age groups and significant labor losses from this disease [Palchun V.T., Kryukov A.I. Otorhinolarynology // M., Medicine, 2001. - 263 p.]. Chronic pharyngitis requires a long, persistent treatment [Palchun V.T., Polyakova B.C., Polivoda A.M. The experience of using the drug vocar in acute and exacerbation of chronic tonsillopharyngitis in adults // Herald of Otorhinolaryngology. - 2008. - No. 1. - S. 57-58]. Treatment of mild cases of pharyngitis is not difficult and consists in the local use of antiseptic solutions. Another situation arises with continuously recurring, long-lasting pharyngitis, supported by the seeding of the nasopharynx and oropharynx. aureus, Str. haemoliticus-β, Klebsiella pneumoniae and the failure of local and systemic immune responses. The main treatment for these diseases is currently antibiotic therapy. However, infectious pathogens are able to adapt to antibiotics and resistance to most chemical antibacterial agents has already been developed in microorganisms. To date, resistance to a number of antibiotics has already formed in St. aureus (MRSA - methicillin-resistant St. aureus), Klebsiella pneumoniae, producing broad-spectrum and wide-spectrum beta-lactamases (Newsletter No. 194, March 2012 - World Health Organization: [Electronic resource]. URL: http: // www.who.int/mediacentre/factsheets/fs194/en (Date of access: 11/20/14) In addition, with massive or prolonged use, antibiotics have an immunosuppressive, myelo-, hepato- and nephrotoxic effect. In most cases, against the background of the use of antibiotics the growth of Candida albicans is activated and develop throughout the gastrointestinal tract dysbiotic disorders. In most cases, antibiotic therapy has only a temporary effect, there is a progressive shortening of the periods of remission between exacerbations of pharyngitis against antibiotic therapy. In connection with the above, the development of effective methods of treatment for chronic pharyngeal inflammation is an urgent task [Kunelskaya N. L., Izotova G.N., Luchsheva Yu.V. et al. Combined local therapy for diseases of the oropharynx // Bulletin of Otorhinolaryngology. - 2008. - No. 2. - S. 62-66].

From the point of view of the main pathogenetic mechanisms of chronic pharyngitis (local disturbance of the immune response, imbalance of pro- and anti-inflammatory cytokines), pathogenetic treatment should be aimed at correcting local (mucosal) immunity factors.

In this regard, one of the most promising areas in the development of preventive and therapeutic measures for chronic pharyngitis is the search for new biostimulants. The maximum therapeutic effect can be achieved with direct contact of the therapeutic agent with the affected organ. There are various methods of local administration of various therapeutic agents.

A known method of treating chronic pharyngitis by introducing drugs under the mucous membrane into the lateral sections of the posterior pharyngeal wall [Palchun V.T., Kryukov A.I. Otorhinolarynology // M., Medicine, 2001. - 263 pp.]: 2 ml of aloe extract and 1 ml of 2% novocaine solution are injected into the lateral sections of the posterior wall of the middle part of the pharynx under the mucous membrane. This method of treatment is carried out in courses of 8-10 procedures, injections are performed with an interval of 7 days. However, the listed method of treatment of chronic pharyngitis has significant disadvantages: the invasive nature of the procedure, the presence of severe pain after administration of drugs (despite the analgesic effect of novocaine), the short duration of clinical effects and the need for multi-course treatment, the immunostimulating effect of the aloe extract solution on the state of mucosal (local ) immunity.

As a method of treating chronic pharyngitis, it is also proposed to introduce under the mucous membrane in the lateral and posterior parts of the oropharynx, on both sides, a 1% solution of emoxipin in a volume of up to 1 ml after application anesthesia with a 2% solution of lidocaine, a course of 5-10 procedures every other day [RU 2281760 IPC A61K 31/167, A61K 31/44, A61P 11/04 publ. 08/20/2006].

The disadvantages of this method include: the invasive nature of the procedure, the pain of the procedure, the absence of a stimulating effect on mucosal immunity.

A known method of treating pharyngitis and tonsillitis by washing the tonsils lacunae once a day and rinsing the throat with mineral water "Ustkachkinskaya 1/99" with a total mineralization of 8.2-8.6 g / m ³ 3-4 times a day for 7-10 days [RU 2204398 IPC A61K 35/08, A61P 11/04 publ. May 20, 2003].

The disadvantages of this method: the lack of effectiveness of the method due to the low concentration of biologically active substances in mineral water, the complexity of the implementation, the short duration of the effect due to the lack of restoration of local immunity.

A known method of treating pharyngitis in which the oropharynx is irrigated using low-frequency ultrasound from the Auzot apparatus with a 0.01% solution of miramistin, to which dimexide is added at a concentration of 50: 1 ml, respectively. Irrigate for 1-5 minutes, taking into account the time of respite. After that, an ultrasonic effect on the mucous membrane of the oropharynx is carried out with the end of the waveguide of this apparatus for 3-5 s at a distance of 2-3 mm from the mucosa [RU 2198704, IPC 7 A61N 7/00, A61P 11/04, publ. 02/20/2003]. The main disadvantage of this method is the complexity of the procedure, requiring hardware treatment.

The closest in technical essence and the achieved result to the claimed invention is a method of treating inflammatory diseases of ENT organs, which consists in introducing a sterile individual antigenic material (SIAM), which is obtained from inflammatory foci of ENT organs, and introducing it intramuscularly at 0.5 ml dose of 2 billion mt in 1.0 ml and intradermally in a dose of 0.5 ml with a dose of 2 million mt in 1.0 ml every other day, 5 intramuscular and intradermal injections at the same time per treatment course [RU 2185190, IPC A61K 39/00 publ. July 20, 2002].

The disadvantages of this method of treatment are: severe pain in the procedure, the risk of allergic reactions to the introduced antigens, up to the development of anaphylactic shock, low immunogenicity of the material used.

The objective of the invention is to create a widely accessible method that increases the effectiveness of the treatment of chronic pharyngitis, which allows to overcome the current problem of resistance of pathogens to antibiotics and reduce the cost of treatment.

The technical result is:

- increasing the effectiveness of the treatment of chronic pharyngitis due to the relief of the inflammatory process and the restoration of immunobiological reactions in the nasopharynx and oropharynx by stimulating mucosal immunity;

- a decrease in the recurrence rate of the disease;

- reduction of treatment costs;

- elimination of the morbidity of the tissues of the pharynx;

- simplification of therapeutic techniques.

The technical result is achieved by a method of treating chronic pharyngitis, characterized by the cultivation of an auto vaccine, by plating a smear from the mucous membrane of the throat on a nutrient medium, followed by isolation of pure cultures of pathogens: Str. haemoliticus-β, or St. aureus, or Klebsiella pneumoniae, by the preparation of an immunomodulating agent consisting of an auto vaccine of 2 wt. hours (1,000,000 microbial particles of a bacterial pathogen strain / ml isolated from the infection site), 0.003-0.005 weight. including polyoxidonium, 2 weight. including a 0.9% aqueous solution of sodium chloride, using an immunomodulating agent in the form of intranasal installations, 1 ml in each half of the nose × 2 times a day after meals, the duration of the course is 7-10 days.

With this method of treating chronic pharyngitis while maintaining the massive growth of pathogens: Str. haemoliticus-β, or St. Aureus, or Klebsiella pneumoniae in the pharynx, re-use the immunomodulating agent 6 months after the first course of treatment.

The difference between the proposed solution and the known ones is the use of an immunomodulating agent based on an auto vaccine in the form of intranasal installations of 1 ml in each half of the nose × 2 times a day after meals, the duration of the course is 7-10 days.

In the literature, there are few works on the use of purulent bacterial infections of auto vaccines prepared from microorganisms isolated from the patient's own foci of disease. However, it turned out that such auto-vaccines are not sufficiently immunogenic. To enhance the effectiveness of the auto-vaccine, it was proposed to add a water-soluble high molecular weight polymer - an N-oxidized derivative of poly-1,4-ethylene piperazine - "polyoxidonium", which has an immunoadjuvant property due to the fact that there are a large number of active groups on its surface. In the treatment of pharyngitis, a mixture of an auto vaccine with polyoxidonium is administered intranasally.

The amount of polyoxidonium added to the composition of the therapeutic agent was selected empirically, taking into account its ability to enhance the immunostimulating effect of the auto vaccine, assessed by an increase in the indices of local immunity - phagocytic index, and level of lysozyme in the oral fluid. When the content in the therapeutic agent polyoxidonium is less than 0.003 weight. including an increase in the indices of the local immune response was not reliable. The addition of polyoxidonium to the therapeutic agent in an amount of 0.003-0.005 weight. including led to a significant increase in the phagocytic index and oral fluid lysozyme (p <0.001). With a further increase in the dose of polyoxidonium (more than 0.005), the increase in the phagocytic index and lysozyme remained at the level of those at a dose of 0.003-0.005.

A method for the treatment of chronic pharyngitis includes the preparation of an auto vaccine and its subsequent use with an immunoadjuvant - polyoxidonium for the treatment of patients.

I. Preparation of auto vaccine

1. A smear is taken from the mucous membrane of the pharynx with a dry sterile probe by rotational movements from the surface of the tonsils, palatine arches and the posterior wall of the oropharynx, autologous vaccines are “grown” by inoculation of the smear from the mucous membrane of the pharynx onto nutrient media (7% meat-peptone blood agar, Kitta medium -Tarozzi, Wednesday Saburo).

2. In parallel with the sowing, smears are made, which are stained according to Gram and viewed under a microscope, which gives a preliminary idea of the spectrum of microorganisms that have fallen into the biological material from the pharynx, and allows you to select the selective medium on which this material will be sown

3. Sowing media are kept in a thermostat at a temperature of 37 ° C for 18 hours for the growth and reproduction of pathogens

4. Further sowing of the grown colonies is carried out to obtain "pure" crops. For this purpose, a smear is made from each grown colony and sowed separately for each colony on media that are kept in a thermostat at a temperature of 37 ° C for 18 hours. After this time, media with seeded material are examined, and attention is paid to the specific features of the growth of microorganisms on a medium, make a smear, color it with the Gram method in order to check the culture for cleanliness. If bacteria of the same morphology, size, and tinctorial properties are observed under a microscope, it is concluded that the culture is pure.

5. The isolated strains differentiate and proceed to their final identification, taking into account the morphological, cultural characteristics of microorganisms, as well as biochemical (proteolytic, hemolytic, reducing and other enzymatic) properties using selective media. Clinical value are Str. haemoliticus-β, St. aureus, Klebsiella pneumoniae - bacterial pathogens of the oropharynx that are of etiological importance in exacerbating chronic pharyngitis (Yu.Kh. Mikhailov, I.V. Mikhailova Etiology of chronic pharyngitis // Theoretical and practical problems of modern medicine: A collection of scientific papers based on the results of a scientific and practical conference dedicated to the 55th anniversary of the Central City Hospital "Ministry of Health and Social Development of the Chuvash Republic. Cheboksary: Publishing House of the Chuvash University, 2015. - S. 127-132).

6. The identified bacteria are washed off using 3-4 ml of physiological saline containing a 0.2-0.3% formalin solution that kills microorganisms.

7. Determine the number of microbial bodies in 1 ml of flush using optical standards GKI them. L.A. Tarasevich.

8. The resulting washings are kept in an thermostat at a temperature of 37 ° C for 36-72 hours, then control sterilization is done on meat-peptone blood agar, Kitta-Tarozzi medium, glucose broth, Saburo medium. Crops are kept in a thermostat at a temperature of 37 ° C for up to 7 days. The vaccine is stored in the refrigerator at a temperature of + 4 ° C. If after 7 days there is no growth on the control media, then the vaccine is diluted with 0.9% aqueous sodium chloride at a concentration of 1,000,000 microbial bodies / ml and is used to treat patients.

II. Patient treatment

An indication for treatment by the developed method is those cases of chronic inflammation of the oropharynx in the acute stage, when only one clinically significant bacterial pathogen, or Str. haemoliticus-β, or St. aureus, or Klebsiella pneumoniae.

For the treatment of patients, a therapeutic agent is prepared, consisting of an auto vaccine of 2 weight. hours (1,000,000 microbial particles of a bacterial pathogen strain / ml isolated from the infection site), 0.003-0.005 weight. including polyoxidonium, 2 weight. h, 0.9% aqueous solution of sodium chloride. In the treatment of pharyngitis, 1 ml of this drug is administered intranasally in each half of the nose × 2 times a day after meals, the duration of the course is 7-10 days.

The essence of the claimed invention lies in the use for local drug therapy of an immunomodulating agent based on an auto-vaccine and an immunoadjuvant, as illustrated by examples 1-3.

Example 1. Patient I., born in 1971, from 02.21.15 to 03.22.15 was on an outpatient basis with an otorhinolaryngologist at the clinic of the City Clinical Hospital No. 1 of the Ministry of Health and Social Development of the Chuvash Republic. When contacting a doctor, she complained of aching sore throat, dryness, cough, general weakness, fever up to 37.2 ° C, bad breath. Anamnesis of the disease: considers himself sick for 5 years, with periodic exacerbations (up to 3-4 times a year, mainly in the cold season), manifested by pain, sore throat, cough. In addition, the patient notes an increased sensitivity to viral infections (herpes virus infections on the lips, nose, SARS 5-6 times a year). Over the past 6 months, the frequency of exacerbations has increased: from August 2014 to February 2015, there were 5 exacerbations of the disease. Moreover, in 4 cases, the disease was stopped only with the appointment of antibiotics (amoxicillin, cephalexin, ciprofloxacin, amoxiclav). Due to the ineffectiveness of the treatment, the patient was sent to an immunologist. When examined by an immunologist: general condition is satisfactory, low nutrition, vesicular breathing in the lungs, no wheezing, muffled heart sounds, rhythmic pulse, 79 beats in 1 min, blood pressure 90/65 mm Hg The edge of the liver at the level of the right hypochondrium, the abdomen is soft, painless on palpation. Submandibular and angular lymph nodes up to 1.5 cm in diameter are palpated, dense, painless on palpation, not fused with surrounding tissues. Axillary lymph nodes 1 × 1 cm, soft, painless on palpation, not fused with surrounding tissues. The tongue is moist, covered with white coating, carious teeth are sanitized, palatine tonsils are not enlarged, slight swelling of the palatine arches. Anterior rhinoscopy: vestibule of the nose on the right and left without features, freely. Nasal septum without features. The mucous membrane of pink color, the middle nasal passages and the common nasal passages on the right and left without features, free. With pharyngoscopy: the mucous membrane of the posterior pharyngeal wall is thinned, dry, pale, shiny, vascular injection is detected, mucus drains. When studying the indices of the local immune response in the oral cavity, a decrease in the phagocytic activity of neutrophils was found: the phagocytic index is 45.1%. The ratio of the level of the pro-inflammatory cytokine IL-1β of the oral fluid to the level of the anti-inflammatory cytokine IL-10 (IL-1β / IL-10) is increased to 5.2. The level of lysozyme of the oral fluid was reduced to 4.5 μg / ml. The result of bacteriological culture from the mucous membrane of the pharynx: massive growth of St. aureus, meager growth of fungi of the genus Candida albicans. Diagnosis: chronic pharyngitis, atrophic form. Complex treatment was carried out: 1. Local application (gargling) of soda-salt solutions, oil-alkaline inhalations 2. General therapeutic treatment - the use of vitamins (aevit, ascorbic acid), enzymes (wobenzym) 3. Intranasal installations of the nasopharynx by introducing into each half of the nose 1 ml of an immunomodulating agent consisting of an auto vaccine - 2 weight. hours (1,000,000 microbial particles of St. aureus / ml), 0.003-0.005 weight. including polyoxidonium, 2 weight. including a 0.9% aqueous solution of sodium chloride, twice a day after meals for 7 days. After 1 month, control studies were carried out: the patient indicated a subjective improvement (the perspiration and dryness in the throat disappeared), no relapse of the disease was observed. With pharyngoscopy: mucus, no vascular injection. A control immunological study of the oral fluid noted: a decrease in the ratio of IL-1β / IL-10 from 5.2 to 2.7, an increase in the phagocytic index from 45.1 to 58.3%, an increase in the level of lysozyme from 4.5 to 6, 1 mcg / ml. The result of bacteriological culture from the mucous membrane of the pharynx showed a positive dynamics of microbiocenosis: Candida albicans was not sown. St. continued to sow aureus, however, its growth rate from “massive” has changed to the level of “meager growth”. Massive growth of resident ("normal") microflora - Str. haemoliticus-α. Katanamnesis (6 months after treatment): recurrence of pharyngitis and acute respiratory viral infections was not observed. The back wall of the pharynx is pink, without pathological changes; massive bacterial growth of Str. haemoliticus-α.

Example 2. Patient P., born in 1982, turned to an immunologist at the outpatient clinic of the City Clinical Hospital No. 1 of the Ministry of Health and Social Development of the Chuvash Republic in the direction of the ENT specialist on 02/25/15. with complaints of burning sensation, dryness, soreness when swallowing, which have constantly worried the patient over the past three years. Medical history: 4 years ago, after the tonsillectomy, the above complaints appeared. Treated with local antiseptic solutions, physiotherapeutic methods without a pronounced effect. Deterioration over the past year. It emphasizes that even in the summer, dryness, sore throat continued to bother. 5 courses of antibiotic therapy were performed (amoxiclav - twice, clarithromycin, ceftriaxone, ciprofloxacin) over the past year. On examination: the amygdala niches are clean, the mucosa of the posterior pharyngeal wall is rather dry in appearance, thinned, vascular injection is detected, vessels of the palatine curtain are injected. The submandibular lymph nodes are palpated 1 × 1.5 cm to the right, 1 × 1 cm to the left, dense, painless on palpation, not fused with surrounding tissues, the chains of the anterior cervical lymph nodes 0.5 × 0.5 cm, dense, painless on palpation, not fused with surrounding tissues. The tongue is moist, densely lined with white coating.

A study of the state of local immunity revealed a decrease in phagocytic activity (phagocytic index was 35.6%). The ratio of the levels of cytokines IL-1β / IL-10 increased to 4.9. The level of lysozyme is reduced (4.1 μg / ml). Bacteriological culture from the mucous membrane of the pharynx revealed a massive growth of Str. haemoliticus-β and Candida albicans. Diagnosis: Chronic pharyngitis, atrophic form. Complex treatment was carried out: 1. Local application (gargling) of miramistin solution, soda-salt solutions 2. General therapeutic treatment - the use of vitamins (aevit, ascorbic acid), wobenzym, ubiquinone 3. Intranasal injections of 2 ml of immunomodulating agent in each half of the nose, consisting from auto vaccine 2 weight. hours (1,000,000 microbial particles of Str. haemoliticus-β / ml), 0.003-0.005 weight. including polyoxidonium, 2 weight. including 0.9% aqueous solution of sodium chloride, twice a day after meals for 10 days. After 1 month, control studies were conducted. At the same time, the patient had no complaints about her state of health, and no relapse of the disease was observed. With pharyngoscopy: mucus, no vascular injection. An immunological control study showed: a decrease in the IL-1β / IL-10 ratio from 4.9 to 2.8, an increase in the phagocytic index from 35.6 to 55.3%, an increase in lysozyme from 4.1 to 6.9 μg / ml The result of bacteriological culture from the mucous membrane of the pharynx showed a positive dynamics of microbiocenosis: the growth of Candida albicans and Str. haemoliticus-β. Catamnesis: no relapse of pharyngitis was observed within 6 months after treatment. In this case, the back wall of the pharynx is pink, without pathological changes, with bacterial sowing from the throat a moderate growth of Str. haemoliticus-α.

Example 3. Patient S., born in 1976, complained of discomfort when swallowing, perspiration, dryness in the nasopharynx, sticky lips in the morning after sleep, bad breath. Anamnesis of the disease: these complaints concern the last 5 years, are treated annually with antibiotics for exacerbation of chronic pharyngitis, worsening during the last 6 months, when after ARVI there was a burning sensation in the throat when swallowing, dryness in the nasopharynx, stickiness of the lips and tongue, body temperature keeps between 37.3-37.5 ° C. During bacterial culture of the smear from the mucous membrane of the throat, Klebsiella pneumoniae was seeded. Over the past 6 months, antibiotic therapy was prescribed three times. The last antibiotic therapy (ciprofloxacin) was used 1.5 months ago. At the last bacteriological examination (1 week ago), Klebsiella pneumoniae (massive growth) and Str. haemoliticus-α (sparse growth), nose - Klebsiella pneumoniae (massive growth). With pharyngoscopy: the mucosa of the posterior pharyngeal wall is thinned, a pale pink hue of the mucosa, the vessels are injected, the mucus on the posterior pharyngeal wall, the palatine arches are swollen, bumpy. The submandibular lymph nodes are palpated 2 × 1.5 cm to the right, 1.5 × 1 cm to the left, dense, painless on palpation, not fused to surrounding tissues. Diagnosis: chronic atrophic nasopharyngitis. In a laboratory study: an increase in IL-1β / IL-10 to 4.7, a decrease in lysozyme content to 3.8 μg / ml, and a phagocytic index of up to 36%.

The complex treatment was carried out: 1. Local application (gargling) of miramistin solution, soda-salt solutions 2. General therapeutic treatment - the use of vitamins (aevit, ascorbic acid), wobenzym, ubiquinone 3. Intranasal injections of 2 ml of immunomodulating agent in each half of the nose, consisting from auto vaccine 2 weight. hours (1,000,000 microbial particles of Klebsiella pneumoniae / ml), 0.003-0.005 weight. including polyoxidonium, 2 weight. including 0.9% aqueous solution of sodium chloride, twice a day after meals for 10 days. After 1 month, control studies were conducted. At the same time, the patient had no complaints about her state of health, and no relapse of the disease was observed. With pharyngoscopy: mucus, vascular injection on the mucous membrane of the posterior pharyngeal wall are not detected, there is no swelling of the palatine arches. The sizes of palpable submandibular lymph nodes decreased to 1 × 0.5 cm on both sides. An immunological control study showed: a decrease in the IL-1β / IL-10 index from 4.7 to 2.5, an increase in lysozyme from 3.8 to 5.9 μg / ml, an increase in the phagocytic index from 36 to 57%. The result of bacteriological culture from the mucous membrane of the pharynx indicates a positive dynamics in the indicators of microbiocenosis: the growth of Klebsiella pneumoniae stopped. Catamnesis: no relapse of pharyngitis was observed within 6 months after treatment, body temperature did not exceed 36.8 ° C. In this case, the back wall of the pharynx is pink, without pathological changes, with a bacteriosis from the throat, only a moderate growth of Str. haemoliticus-α, from the nose - St. epidermalis.

The developed method was tested in the treatment of 14 patients with chronic pharyngitis - the main group. The comparison group included 15 patients treated in the generally accepted way (oral antibiotic therapy according to the sensitivity of microflora extracted from the throat to antibiotics, topical application of miramistin solution, soda-salt solutions, oil-alkaline inhalations; general therapeutic treatment with vitamins - “Aevit”, ascorbic acid , energy and metabolic therapy with wobenzym, ubiquinone). Both groups were represented by patients with atrophic and subatrophic pharyngitis, homogeneous in sex (2/3 of the examined were female, 1/3 were male), age composition (from 21 to 62 years old), concomitant pathology, and the presence of bad habits. Assessment of the results of the study, indicators of clinical status, mucosal immunity, cytokine profile and bacteriological culture from the mucous membrane of the throat was performed before treatment, 5 days, 1 month and 6 months after completion of the course of treatment. The results of testing are given in table. one.

In the course of treatment, in patients treated with the standard method using antibacterial agents, IL-1β / IL-10 decreased by day 5 after treatment, while in the other group receiving intranasal installations of the drug based on autologous vaccine and polyoxidonium rate increased. However, later, by 1 and 6 months after treatment, this indicator in the main group turned out to be lower than the initial value, and in the comparison group the indicator 6 months was higher than the initial one. These data indicate that as a result of treatment with an immunomodulatory agent, by the 5th day of the post-treatment period, the inflammatory process intensified, and then by 1 month it became lower than the initial level, maintaining a decreasing trend by 6 months. In the comparison group, on the contrary, the inflammatory process decreased by the 5th day of the cessation of treatment, and then, after its cancellation, it apparently started to rise and turned out to be 6 months above the initial level. The phagocytic activity of leukocytes increased progressively in the main group, starting as early as 5 days from the moment of discontinuation of treatment. In the comparison group, this indicator was 1 month higher than the initial one, and by 6 months it did not differ from the initially reduced value.

In the main group after treatment, from 1 month after treatment, an increase in the colonization of the mucous membrane of the pharynx by the “normal” microflora — Str. haemoliticus-α against the background of cessation of growth of Candida albicans fungi in 7 out of 10 patients. By 6 months, 9 out of 10 patients had eliminated Candida albicans. Moreover, in the comparison group, the growth of Str. haemoliticus-β was reduced from baseline on day 5 after antibiotic therapy. In the main group, a tendency toward a decrease in the growth of Str. haemoliticus-β, St. aureus and Klebsiella pneumoniae: by 6 months, the percentage of people with revealed growth decreased by 21.4%, 14.3% and 14.2%, respectively. At the same time aureus and Klebsiella pneumoniae began to be detected by the same time more often in the comparison group: the first - by 6.7%, the second - by 26.7%.

The average number of exacerbations was significantly lower in the main group at 1 and 6 and 12 months after treatment.

Thus, using the developed method (intranasal installations of auto vaccine and polyoxidonium) for the treatment of patients with chronic pharyngitis, 6 months after the course of treatment, elimination of Candida albicans (in 9 out of 10 patients) and pathogenic microorganisms - Str. haemoliticus-β (in 2 out of 5 patients), St. aureus (in 3 out of 5 patients) and Klebsiella pneumoniae (in 2 of 4 patients). In the comparison group receiving antibiotic therapy, on the contrary, there was an increase in the percentage of individuals with detected seeding of microorganisms.

6 months after the first course of treatment, patients of the main group with ongoing seeding of Str. haemoliticus-β, St. aureus and Klebsiella pneumoniae underwent repeated treatment with an immunomodulating agent, after 1 month and 6 months after which repeated bacteriological culture was carried out from the mucous membrane of patients' pharynx. An analysis of the results showed that 6 months after reuse of the immunomodulating agent in all patients, elimination from the mucous membrane of the Str pharynx occurred. haemoliticus-β and Klebsiella pneumoniae and only in 1 out of 3 patients with St. aureus continued to sow this microorganism.

A follow-up examination after 12 months showed that the number of exacerbations of the disease in patients of the main group (0.14 ± 0.1) is significantly (p <0.001) lower than that in the comparison group (6.53 ± 0.42).

Thus, the use of the proposed method for the treatment of severe forms of chronic pharyngitis is more effective than the generally accepted method involving the use of antibiotic therapy, as evidenced by: a decrease in the frequency of exacerbation; fast and lasting treatment result; improved indices of the local immune response. However, this method does not have side effects.

Claims (2)

1. A method for the treatment of chronic pharyngitis, characterized by the cultivation of an auto vaccine, by inoculating a smear from the mucous membrane of the throat on a nutrient medium, followed by isolation of pure cultures of pathogens: Str. haemoliticus-β, or St. aureus, or Klebsiella pneumoniae, by the preparation of an immunomodulating agent consisting of an auto vaccine of 2 wt. hours (1,000,000 microbial particles of a bacterial pathogen strain / ml isolated from the infection site), 0.003-0.005 weight. including polyoxidonium, 2 weight. including a 0.9% aqueous solution of sodium chloride, using an immunomodulating agent in the form of intranasal installations, 1 ml in each half of the nose × 2 times a day after meals, the duration of the course is 7-10 days. 2. A method for the treatment of chronic pharyngitis according to claim 1, characterized in that while maintaining the massive growth of pathogens: Str. haemoliticus-β, or St. Aureus, or Klebsiella pneumoniae in the pharynx, re-use the immunomodulating agent 6 months after the first course of treatment.