RU2452495C1 - Method of treating pulmonary tuberculosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine. A method of treating pulmonary tuberculosis involves anti-tuberculosis conventional therapy with prescribing a therapeutic course of a complex of homoeopathic preparations five grains three times a day without regard to the food intake including carbo vegetabilis 6, and the preparations in equal proportions with carbo vegetabilis 6: manganum aceticum 6, millefolium 6, mercurius cyanatus 6, acidum nitricum 6, acidum fluoricum 6, creosote 6, drosera 6. The complex is included in an intensive phase of the course from first day of treatment.

EFFECT: method enables accelerating the disappearance of clinical manifestations of pulmonary tuberculosis, improving clinical effectiveness by the criteria of cavity closure, infiltration dispersion and abacillation in the patients with drug resistance of tuberculosis mycobacteria to anti-tuberculosis preparations.

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Description

The invention relates to medicine, namely to phthisiology, and can be used in the complex treatment of patients with pulmonary tuberculosis with drug resistance of Mycobacterium tuberculosis (MBT) to anti-TB drugs.

The high incidence of pulmonary tuberculosis in Russia and around the world remains one of the most acute medical and socio-economic problems.

Over the past two decades, the attention of clinicians has been attracted by the problem of anti-tuberculosis therapy of tuberculosis, and especially pulmonary tuberculosis, due to a sharp increase in the incidence of this infection and an increase in the number of destructive forms of pulmonary tuberculosis, accompanied by massive excretion of mycobacterium tuberculosis. In recent years, there has been a significant increase in the resistance of tuberculosis mycobacteria to the main anti-TB drugs.

The reason for the development of drug-resistant forms of the office is the state of the body's immune system. If the protective mechanisms of the macroorganism are sufficiently active, the few drug-resistant mycobacteria that appear during treatment can be suppressed and treatment remains effective. If the natural protective mechanisms are inhibited, then during the treatment process there is a constant increase in the number of resistant forms, as they multiply unhindered. The ability of drug-resistant strains of the office to multiply intensively in the body is the cause of the ineffectiveness of anti-TB treatment when drug resistance appears.

The leading method in the treatment of pulmonary tuberculosis is therapy with anti-TB drugs, which is regulated by order of the Ministry of Health of the Russian Federation dated March 21, 2003 No. 109 “On improving anti-TB care in the Russian Federation” and defines the main direction in the future in the fight against tuberculosis. However, many years of experience in the use of anti-TB treatment for pulmonary tuberculosis indicates an insufficient clinical and radiological effect of standard treatment regimens. The disadvantages of standard anti-TB treatment are the rapid emergence of drug resistance of Mycobacterium tuberculosis to these drugs, toxic reactions from the liver, gastrointestinal tract and nervous system, and weakening of the immune status. In addition, due to extensive fibrotic changes in the lungs in patients with chronic forms of tuberculosis, the bioavailability of anti-TB drugs to the lung tissue is quite low.

All this makes us look for new effective ways to treat pulmonary tuberculosis.

Conducted research of medical, scientific and patent literature identified various methods of treatment of pulmonary tuberculosis.

So in the work of G.Yu. Vasilyeva and G.S. Balasanyants. The experience of using bestim in the complex treatment of infiltrative destructive forms of pulmonary tuberculosis (Family Doctor magazine, 2003, No. 3, pp. 17-19) describes a method for treating pulmonary tuberculosis, including 0.1 mg intramuscularly Bestim immunomodulator treatment daily , for the course of treatment 5 injections.

In the work of S.S. Arshinova and B.V. Pinegin. Immunomodulators in the treatment of patients with active pulmonary tuberculosis (Journal of the attending physician, October 2002, No. 10, pp. 36-37) describes a method for the treatment of pulmonary tuberculosis, which includes the introduction of 6 mg polyoxidonium intramuscularly into the course of anti-tuberculosis therapy 2 times a week, 10 injections per treatment course.

In the work of A.S. Svistunov and B.V. Pinegin. The use of an immunomodulator of lycopide in the complex treatment of pulmonary tuberculosis (Journal of Problems of Tuberculosis, 2002, No. 3, p.21-25) describes a method for the treatment of pulmonary tuberculosis with the inclusion of 10 mg of lycopide once a day for 10 days.

RF patent No. 2219939 (BIMP No. 36, 2003), protected the "Method for the treatment of pulmonary tuberculosis", which provides for the use of the probiotic bactisporin containing a live culture of bacteria Bacillus subtilis 3H on the background of anti-tuberculosis therapy. The drug is prescribed 4 doses 3 times a day for 5-7 days, then 1 dose 2 times a day for 10-15 days, 30 minutes before treatment.

RF patent No. 2253460 (BIPM No. 16, 2005) protected the "Method for the treatment of pulmonary tuberculosis", which provides for the inclusion of zinc sulfate in the treatment regimen, which potentiates the effect of anti-TB drugs. Zinc sulfate is prescribed in a daily dose of 2.3-3.5 mg / kg for oral administration 2-3 times, the course of treatment is 21-28 days.

RF patent No. 2242222 (BIMP No. 35, 2004) protected the "Method for the treatment of focal and infiltrative pulmonary tuberculosis", which provides for the additional introduction of amixin into the course of anti-tuberculosis treatment. Amiksin is prescribed in a dose of 0.125 mg for 36 days: the first two days, 2 tablets, then 1 tablet after 48 hours.

The disadvantages of the above methods of treating pulmonary tuberculosis are their lack of effectiveness with respect to closure of decay cavities, resorption of infiltration and abacillation, and prolonged preservation of the clinical manifestations of the disease.

The closest in nature and taken as a prototype is the "Method for the treatment of pulmonary tuberculosis", protected by RF patent No. 2302251 (BIMP No. 19, 2007). The method provides for anti-tuberculosis therapy according to standard regimes with the inclusion in the course of treatment of a complex of homeopathic preparations containing carbo vegetabilis 6, apis mellifica 6, quina officinalis 6, helidonium mayus 6, stannum 6, sanguine canadensis 6, potassium bichromicum 6, five grains three times per day for 3-4 months, regardless of food intake. The disadvantage of this method is the low effectiveness of the treatment in terms of resorption of infiltration, closure of decay cavities and abacillation in patients with pulmonary tuberculosis with drug-resistant MBT to anti-tuberculosis drugs.

The aim of the invention is to increase the effectiveness of the treatment of pulmonary tuberculosis, namely, reducing the terms of abacillation, resorption of infiltration, closing of decay cavities in patients with drug-resistant MBT to anti-TB drugs.

This goal is achieved by prescribing anti-tuberculosis therapy according to standard regimens with the inclusion of five grains three times a day in the course of treatment, regardless of the meal of the complex of homeopathic preparations containing carbo vegetabilis 6. The complex of homeopathic preparations is prescribed in the intensive phase of the course of treatment from the first day. The complex contains, equal to 6 carbo vegetabilis, homeopathic preparations: manganum aceticum 6, millefodium 6, mercuricius cyanatus 6, azidum nitricum 6, azidum fluoricum 6, creosote 6, drozer 6.

Patients isolating drug-resistant strains of MBT showed a clear relationship between the presence of immune disorders and drug resistance of mycobacteria (Shovkun L.A., Romantseva N.E. Changes in the immune status of patients with drug-resistant forms of tuberculosis during treatment with potentiated homeopathic medicines // Allergology and immunology - 2007, T. 8, No. 1, S. - 65). This is manifested by a decrease in the number of CD3 + lymphocytes, an immunoregulatory index, a decrease in the number of T-helpers, inhibition of IL-2 production, increased synthesis of anti-tuberculosis antibodies with a decrease in the concentration of CIC in the blood serum, an increase in the level of IL-4 and a decrease in IFN-γ (in comparison with patients The homeopathic complex through the central mechanisms of regulation of homeostasis affects the adaptive immune response, normalizes the level of T-helpers, immunoregulatory index, increases production ktsiyu IL-2 and IFN-γ, reduces the level of IL-4. Thus, the activation of Th-1 immune response, which contributes to suppression of the growth and reproduction of drug-resistant strains and MW affects the efficiency of treatment of patients with drug-resistant.

The choice of the composition of the complex of homeopathic preparations, the ratio of its parts and dosage were based on the results of the authors' studies, the fact of suppression of drug resistance, the totality of the main clinical symptoms of pulmonary tuberculosis, and the pathogenetic mechanisms of their development. Homeopathic remedies have the ability to restore impaired homeostasis at the level of regulation of the higher parts of the central nervous system and the immunological state of the body, which favorably affects the dynamics of clinical symptoms and helps to reduce the time of abacillation and closure of decay cavities. So manganum aceticum 6 has a regenerating effect on the mucosa of the upper respiratory tract, serous membranes of the stomach, eliminates cough, shortness of breath, sweating, sputum production; Mercury cyanatus 6, Acidum nitricum 6, Acidum fluoricum 6 contribute to the closure of decay cavities in the lung tissue, resorption of infiltrative changes, and Droser 6 reduces hypoxia and respiratory failure with shortness of breath, dry cough; Milefolium 6 contributes to the cessation of cough with the release of bloody sputum, used for hemoptysis; carbo vegetabilis 6 helps to restore the state of the cardiovascular and respiratory systems, improves the course of redox processes.

The method is as follows.

After examination and diagnosis, the patient is prescribed anti-tuberculosis therapy according to standard regimens. At the same time, from the first day into the intensive phase of treatment, they include a complex of homeopathic preparations containing equal amounts of carbo vegetabilis 6, manganum aceticum 6, millefolium 6, mercurius cyanatus 6, azidum nitricum 6, azidum fluoricum 6, creosote 6, drozer 6, three grains of three. once a day, regardless of food intake.

The feasibility of the proposed method is illustrated by examples from clinical practice.

Example 1: patient A., 38 years old, medical history No. 1143/57, was admitted to hospital in 1 pulmonary therapy unit of the Rostov branch of the State Regional Healthcare Institution “Tuberculosis Clinical Dispensary” of the Rostov Region for infiltrative tuberculosis of the upper lobe of the left lung in phase decay and seeding, MBT +.

Considers herself ill for about two months, when the temperature rose, there was weakness, pain in the chest, cough with sputum. He had contact with a brother with tuberculosis. The patient's condition upon admission to the department is moderate, the skin is pale. Lowered nutrition. Auscultatory - vesicular breathing is heard in the lungs, a few small bubbly moist rales after coughing on the left under the collarbone. Respiratory rate - 26 in 1 minute.

Survey data at admission:

Blood test: hemoglobin - 122 g / l, red blood cells - 4.1.0 × l0 ¹² / l, white blood cells - 9.2 × 10 ⁹ / l, eosinophils - 2%, stab neutrophils - 6%, segmented neutrophils - 68% lymphocytes - 22%, monocytes - 2, ESR - 28 mm / hour.

X-ray and tomograms of a trace in the upper lobe, against the background of pneumosclerosis, inhomogeneous lung tissue infiltration without clear contours, focal structure, with a decay cavity up to 3.8 cm in diameter, with polymorphic foci around and in S6 on the left, with a wide broncho-vascular " path "to the root of the lung.

Results of sputum analyzes performed twice by bacterioscopy - acid-resistant mycobacteria (CMC) were found: 10-15 in the field of view.

Two sputum cultures gave rise to Mycobacterium tuberculosis (MBT): 20 colonies and 5 colonies, respectively.

Sowing the selected culture of the office on a nutrient medium with the addition of anti-TB drugs (PTP) revealed the resistance of the office to streptomycin (S) and isoniazid (H).

Mantoux test with 2 tuberculin units (TE) - 19 mm.

Based on the data of clinical, x-ray and laboratory examination, the patient was diagnosed with infiltrative tuberculosis of the upper lobe of the left lung in the phase of decay and contamination, MBT +. Drug resistance (S, H).

The patient was prescribed treatment according to the claimed method. The standard anti-tuberculosis therapy is streptomycin 1 g, isoniazid 0.6 g, rifampicin 0.6 g, pyrazinamide 1.5 g, ethambutol 1.6 g. At the same time, a complex of homeopathic preparations was added to the intensive phase of the course of treatment from the first day. lobes: carbo vegetabilis 6, manganum aceticum 6, millefolium 6, mercurius cyanatus 6, azidum nitricum 6, azidum fluoricum 6, creosote 6, drozer 6, five grains three times a day, regardless of food intake. Monitoring of treatment results was carried out throughout the course of therapy.

The data of the control examination 4 months after treatment carried out according to the claimed method:

Blood test: hemoglobin - 138 g / l, red blood cells - 4.5 × 10 ¹² / l, white blood cells - 6.7 × 10 ⁹ / l, eosinophils - 2, stab neutrophils - 3%, segmented neutrophils - 66%, lymphocytes - 27%, monocytes - 2%, ESR - 8 mm / hour.

X-ray and tomograms - pneumosclerosis, groups of foci of various contours and densities in the upper lobe on the left. In comparison with the radiograph and tomograms upon admission to the department - resorption of infiltration and densification of foci, closing the cavity of decay.

Sputum analysis was performed twice by bacterioscopy - no CMCs were found.

Two cultures of sputum on MBT: there is no growth of MBT culture, which confirmed the suppression of MBT strains drug-resistant to streptomycin and isoniazid.

Objectively: the patient's condition is satisfactory. Food is moderate, the skin is of normal color. No complaints. Auscultatory - vesicular breathing in the lungs, catarrhal phenomena are not audible. In satisfactory condition, the patient was discharged to outpatient treatment with a diagnosis of Infiltrative tuberculosis of the upper lobe of the left lung in the phase of resorption and compaction, MBT-.

Thus, in a patient with drug-resistant MBT to anti-TB drugs as a result of treatment carried out according to the claimed method, the closure of the decay cavity, resorption of infiltration, abacillation was achieved 4 months after the start of treatment.

Example 2: Patient B., 39 years old, medical history No. 10124/81, was admitted to hospital in 1 pulmonary therapy unit of the Rostov branch of the State Regional Healthcare Institution “Tuberculosis Clinical Dispensary” of the Rostov Region for disseminated pulmonary tuberculosis in the phase of infiltration and decay , Office +.

Her health worsened a month ago, and therefore, the patient was hospitalized. Had contact with a husband with tuberculosis. Complaints upon admission of fever, weakness, decreased ability to work, cough with sputum, shortness of breath, decreased appetite and weight loss.

Survey data at admission:

Blood test: hemoglobin - 142 g / l, red blood cells - 5.2 × 10 ¹² / l, white blood cells - 11.8 × 10 ⁹ / l, eosinophils - 3%, stab neutrophils - 8%, segmented neutrophils - 68%, lymphocytes - 18%, monocytes - 3%, ESR - 28 mm / hour.

X-ray and tomograms - in the lungs across all pulmonary fields, unevenly distributed different-sized, polymorphic foci, sometimes confluent, with destruction of the lung tissue from 1 cm to 2 cm in diameter, the roots of the lungs are not quite structural, dilated.

Sputum analyzes performed twice by bacterioscopy - CMC found: 35-50 in the field of view.

Two sputum cultures gave an abundant growth of mycobacterium tuberculosis.

Sowing the selected culture of the office on a nutrient medium with the addition of anti-TB drugs revealed the resistance of the office to kanamycin (K), isoniazid (H) and ethambutol (E).

On the basis of clinical, radiological and laboratory examination data in the patient’s department, the diagnosis was made: disseminated pulmonary tuberculosis in the phase of infiltration and decay, MBT +. Drug resistance (K, H, E).

The patient was prescribed treatment according to the claimed method. Standard anti-TB therapy is kanamycin 1.0 g, isoniazid 0.6 g, pyrazinamide 1.5 g, rifampicin 0.6 g, ethambutol 1.2 g. At the same time, from the first day, a complex of homeopathic medicines was added to the intensive phase of the treatment course, containing in equal proportions carbo vegetabilis 6, manganum aceticum 6, millefolium 6, mercurius cyanatus 6, azidum nitricum 6, azidum fluoricum 6, creosote 6, drozer 6, five grains three times a day, regardless of the reception, write The treatment results were monitored throughout the entire course of therapy.

Data follow-up examination after treatment carried out according to the claimed method:

Blood test: hemoglobin - 148 g / l, red blood cells - 4.5 × 10 ¹² / l, white blood cells - 6.9 × 10 ⁹ / l, eosinophils - 1%, stab neutrophils - 5%, segmented neutrophils - 64%, lymphocytes - 27%, monocytes - 3%, ESR - 6 mm / hour.

X-ray and tomograms - in the upper lobes and S6 of both lungs, against the background of pneumosclerosis, polymorphic foci of different size, contour and density. The roots of the lungs are slightly pulled up. Compared with the radiograph upon admission - resorption of infiltration, a decrease in the number of foci and their compaction, closing the destruction of the lung tissue.

Two sputum analyzes by bacterioscopy: no CMC found.

Two cultures of sputum on the office: there is no growth of the culture of the office, which confirmed the suppression of drug-resistant strains of the office.

In satisfactory condition, the patient was discharged to outpatient treatment with a diagnosis of disseminated pulmonary tuberculosis in the phase of resorption and compaction, MBT-.

Thus, as a result of treatment carried out according to the claimed method, in a patient with drug resistance of MBT to anti-TB drugs, the closure of the decay cavity, resorption of infiltration, and abacillation were achieved 4 months after the start of treatment.

We observed 35 patients with pulmonary tuberculosis with drug resistance to anti-TB drugs.

The main group consisted of 7 patients who received treatment according to the claimed method - in addition to the intensive phase of the course of anti-tuberculosis therapy according to standard regimens, from the first day a complex of homeopathic preparations was included, containing in equal proportions carbo vegetabilis 6, manganum aceticum 6, millefolium 6, mercurius cyanatus 6, acidum nitricum 6, acidum fluoricum 6, creosote 6, drozer 6, five grains three times a day, regardless of food intake.

A comparison group consisted of 21 patients who received treatment according to the prototype, who, against the background of standard anti-tuberculosis therapy, were additionally prescribed a homeopathic complex containing apis mellifix 6, quin ofocinalis 6, helidonium mayus 6, stannum 6, sanguinarium canadensis 6, Kalium bichromicum 6 , carbo vegetabilis 6 five grains three times a day for 4 months regardless of food intake (Shovkun L.A., Romantseva N.E. Changes in the immune status of patients with drug-resistant forms of tuberculosis in the treatment of potentiated homeopathic medicines // Allergology and Immunology - 2007, T.8, No. 1, C. - 65).

The control group included 7 patients who received treatment only according to standard anti-TB treatment regimens.

The treatment results were evaluated every 2 months according to the indicators of closure of decay cavities, resorption of infiltration, abacillation, and the presence of clinical manifestations.

The dynamics of the clinical manifestations of pulmonary tuberculosis in patients with drug-resistant MBT to anti-TB drugs are shown in table 1, treatment efficacy indicators are shown in table 2.

Table 1
The dynamics of the clinical manifestations of pulmonary tuberculosis in patients with drug resistance of mycobacteria to antituberculosis drugs Clinical manifestations The main group (n = 7) Comparison Group (n = 21) Control group (n = 7) before treatment after 4 months before treatment after 4 months before treatment after 4 months Weakness 7 pax - one hundred% 1 pax - 14.3% 19 people - 90.5% 6 people - 28.6% 6 people - 85.7% 4 pax - 57.1% Temperature rise 5 pax - 71.4% 0 pax - 0% 15 people - 71.4% 4 pax - 19.0% 6 people - 85.7% 3 people - 42.8% Mass deficit 4 pax - 57.1% 0 pax - 0% 20 pax - 95.2% 3 pax - 1-4.3% 3 pax - 42.8% 2 pax - 28.8%. Cough 6 people - 85.7% 1 pax - 14.3% 21 pax - 100.0% 6 people - 28.6% 5 pax - 71.4% 4 pax - 57.1% Sputum discharge 3 pax - 42.8% 0 pax - 0% 20 pax - 95.2% 8 pax - 38.1% 3 pax - 42.8% 3 pax - 42.8% Dyspnea 4 pax - 57.1% 1 pax - 14.3% 18 pax - 85.7% 7 pax - 33.3% 3 pax - 42.8% 3 pax - 42.8%

As can be seen from table 1, in most patients of the main group after 4 months of treatment carried out in accordance with the claimed method, the clinical manifestations of pulmonary tuberculosis disappeared. In patients of the comparison group, the disappearance of the clinical manifestations of tuberculosis was observed less frequently, and in patients of the control group, the clinical symptoms of tuberculosis persisted.

table 2
The effectiveness of the treatment of pulmonary tuberculosis with drug resistance of mycobacteria to anti-TB drugs after 4 months of treatment Indicators The main group (n = 7) Comparison Group (n = 21) Control group (n = 7) Decay cavity closure 4 pax - 57.1% 6 people - 28.6% 2 pax - 28.6% Abacillation 5 pax - 71.4% 13 pax - 61.9% 3 pax - 42.8% Resorption of infiltration 5 pax - 71.4% 10 pax - 47.6% 3 pax - 42.8%

As can be seen from table 2, as a result of treatment carried out in accordance with the claimed method, in patients of the main group revealed an increase in the effectiveness of treatment. The closure rate of decay cavities in patients of the main group is 2 times higher than in patients of the comparison group and patients of the control group. The abacillation rate in patients of the main group is 1.2 times higher than in patients in the comparison group, and 1.7 times higher in comparison with patients in the control group. Resorption of infiltration in patients of the main group was observed 1.5 times more often than in patients of the comparison group, and 1.7 times more often than in patients of the control group.

Thus, the proposed method for the treatment of pulmonary tuberculosis in patients with drug resistance of mycobacterium tuberculosis to anti-TB drugs, in comparison with the prototype, can accelerate the disappearance of the clinical manifestations of the disease, increase the effectiveness of treatment in terms of closing decay cavities, resorption of infiltration and abacillation by suppressing drug-resistant strains of mycobacterium tuberculosis.

Claims (1)

A method of treating pulmonary tuberculosis, which provides for anti-tuberculosis therapy according to standard regimes with five grains three times a day, regardless of the meal of a complex of homeopathic preparations, including carbo vegetabilis 6, characterized in that the complex of homeopathic preparations contains equal carbo vegetabilis 6 lobes; preparations: manganum aceticum 6, millefolium 6, mercurius cyanatus 6, azidum nitricum 6, azidum fluoricum 6, creosote 6, drozer 6; the complex is included in the intensive phase of the course from the first day of treatment.