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INVENTION
Patent of the Russian Federation RU2219981
METHOD OF TREATMENT OF FURUNKULOSIS
The name of the inventor: Chernyshev VI; Sorochkina LM; Udodenko V.G.
The name of the patent holder: Chernyshev Vladimir Ivanovich
Address for correspondence: 309512, Belgorod Region, Stariy Oskol, Makarenko Microdistrict, 29, ap. 246, V.I. Chernyshov
Date of commencement of the patent: 2001.12.20
The invention relates to medicine and can be used in dermatology and surgery for the treatment of furunculosis. The method consists in that the patient is sampled from all parts of the nasal passage, starting from the distal, each nasal passage, smears from tonsils and pharynx, bacteriological examination of the material taken and in the presence of nasopharyngeal carriage. Aureus in patients perform complete sanation of the nasal passages, tonsils and pharynx with antibacterial 2% intranosal ointment Bactroban (monotherapy). Treatment with ointment was performed 2-3 times a day for 5-8 days with subsequent clinical and bacteriological control. In addition, as an antibacterial agent, antibiotics sensitive to St. Aureus. The technical result: the method of treatment is absolutely etiopathogenetic and provides 100% remission.
DESCRIPTION OF THE INVENTION
The invention relates to medicine, more specifically to surgery and dermatology, and can be used in the treatment of furunculosis.
It is known that the treatment of furuncles traditionally involves a complex approach, which includes opening and draining the purulent focus, carrying out antibacterial and desensitizing therapy, administering analgesics, physiotherapy (T. Robustova, Surgical Dentistry 1990, pp. 278-280).
Among them, it should be noted the method, including the use of splenin in the complex treatment of patients with chronic furunculosis (Clinical Allergology and Immunology, Proceedings of the 2nd International Conference of the 1st Congress of BAAKI, Minsk, 1992, 249), surgical treatment of furuncles and irradiation with laser light Patent 2101046 from 10.01.98), simultaneous use of complex therapy and ultraviolet irradiation of autoblood (Bulletin of Otolaryngology, 1989, 4, p. 90), and antibacterial therapy in combination with the use of medical leeches (patent 2147437 dated April 20, 2000). However, none of these methods can not achieve long-term remission and a reduction in the number of relapses.
Studies of recent years indicate the etiological role of Staphylococcus aureus in the development of purulent inflammatory diseases and the origin of furuncles (Bukharin OV et al., Etiological role of staphylococcal bacteriocarrier in the origin of the furuncle of the nose), 7th Congress of Otorhinolaryngologists of the Ukrainian SSR, Kiev, 1989, page 46). It was also established that the strain of staphylococcus possesses a high antibiotic resistance (Baranova ID New approaches to the treatment of chronic furunculosis with the help of modern immunomodulators.) Abstract of Dissertations for the Candidate of Medical Sciences, Candidate of Medical Sciences, Moscow, 1999). According to the results obtained by Baranova ID, the re-establishment of 80% of cases of chronic infection in combination with adequately selected immunotropic therapy allowed stable remission in 75% of patients. In another method of treatment, and aimed at a general increase in immunity in patients with chronic furunculosis with polyoxidonium and lycopene, remission is achieved only in 42.8% of cases (Setdikova N.Kh., etc. Complex mechanisms of development of chronic recurrent furunculosis and the ways of their correction. , 2000, 05-06).
In the dissertation IA. Shulgi (Furuncle of the nose, Author's Abstract of the Social Science Department of the Moscow Medical Academy, Samara, 1996) describes another method for the treatment of furunculosis (a prototype). With the help of planting flora from the mucous membrane of the anterior nose and skin of the external nose, the author showed that in patients who underwent furunculosis, the persistence of staphylococci on the mucosa of the anterior nasal passages is a risk factor for the recurrence of this pathology. The study allowed to detect the presence of staphylococcus in 55.3% of cases, in 4.6% of patients, nasal furuncle was a manifestation of common furunculosis. The method of treatment proposed by IA Shulga includes the complex use of antibacterial detoxification, anticoagulant, hyposensitizing and stimulating drugs. In this case, recurrences of the disease were observed in 9.6% of cases.
Thus, the analysis of known methods of treatment of furunculosis shows that none of them is etiopathogenetic.
The present invention is based on the discovery of the presence of nasopharyngeal carriage for the first time. Aureus in patients with furunculosis. It has been established that an adequate mucus intake from all parts of the nasal passage, and not just its vestibules, and tonsils and throats, is an indispensable condition for a successful bacteriological examination to identify the carriage of St. Aureus in all patients with furunculosis.
No less important aspect of the invention is the establishment of the fact that when a bacteriologically confirmed complete sanation is achieved with antibacterial agents of the nasal passages, and tonsils and pharynx, a prolonged remission occurs.
These provisions form the basis of the present invention.
The subject of the invention is a method for the treatment of furunculosis, characterized in that the patient from all nasal passage sections takes mucus, smears from tonsils and pharynx, conducts bacteriological examination and in the presence of nasopharyngeal carriage. Aureus completely sanitize the nasal passages, tonsils and pharynx with antibacterial agents until negative control bacteriological examination.
At the same time as an antibacterial agent used 2% ointment "Bactroban" 2-3 times a day, and antibiotics sensitive to St. Petersburg. Aureus.
The proposed method of treatment of furunculosis provides etiopathogenetic treatment of furunculosis due to the fact that a certain etiopathogenesis of the disease has been identified. In addition, the method prevents relapses of the disease, allows for long-term remission, and, in addition, eliminates the need for comprehensive, not entirely justified treatment.
The method is carried out as follows
The patients were examined and treated in the Central District and City Hospital 2 in Stary Oskol. 48 patients with furunculosis were examined: 26 children aged 1 to 13 years, 14 teenagers aged from 14 to 18 years and 8 patients aged 19 to 40 years. Duration of the disease was: in 8% of patients - up to 1 month, 56% - 1-3 months and 36% - 4-8 months. For the first time, 38% of patients applied for help, and the remaining 62% - repeatedly (2-6 times) were treated out-patient (14%) and inpatient (86%) of different medical institutions.
All patients who applied for help - with furunculosis, which was manifested by the presence in each patient of at least 2 furuncles of any degree of maturity in any part of the body or the presence of 1 furuncle, which appeared no more than 1 month after the appearance of the previous one. At the same time, patients with a newly emerged single furuncle were excluded.
At all patients at primary survey the swabs from a nasopharynx are taken. The mucus was removed from all parts of the nasal passage, starting from the distal one. A separate thin swab took material from all parts of each nasal passage, starting from the distal ends of them. The depth of penetration into the nasal passage was: for children - 2 cm, for adolescents - 2.5-3 cm, for adults - more than 3 cm. Having reached the swab of the distal part of the stroke, they made several rotational movements, Movement. Thus, the mucus was taken not only from the vestibule of the nose, but from all its departments. Smears from tonsils and throats were taken in the usual way with one separate tampon. The delivery time to the laboratory did not exceed 40 minutes. A bacteriological study of the material was carried out. From the nasopharynx of all 48 patients, 100% is isolated and grown in the form of pure culture. Aureus. Of the nose, the causative agent was isolated in 82% of patients, with tonsils and throats - in 8% and simultaneously from all structures - in 10%. The degree of dissemination varies: from single (16% of patients) to multiple (84% of patients) colonies.
In the presence of nasopharyngeal carriage Aureus in patients completely sanitized the nasal passages, tonsils and pharynx with antibacterial 2% intranasal ointment Bactroban (monotherapy). Treatment with ointment was performed 2-3 times a day for 5-8 days with subsequent clinical and bacteriological control. As an antibacterial agent, antibiotics sensitive to St. Aureus, which were administered parenterally in a dose necessary before the absence of a pathogenic microflora in a control bacteriological study.
With bacteriologically confirmed complete sanation of the nasopharynx and in subsequent periods (up to 3 years), patients with new furuncles did not appear. Ratio: sanated nasopharynx - remission of the disease was 1: 1. The average period of rehabilitation is 6 days.
The examples below are intended to illustrate the invention without limiting its scope.
Example 1
Patient V., 2 years old, suffered from furunculosis from the first weeks of life. Localization of furuncles: buttocks, hips. The interval between the appearance of new furuncles is from 1 to 4 weeks. She was repeatedly examined and treated in various medical institutions where various, empirically selected antibiotics with antistaphylococcal activity (cefotaxime, gentamicin, etc.), immunomodulators (thymogen), and multivitamins were prescribed. This treatment did not lead to remission.
At our examination, the child was found 4 furuncles in the phase of infiltration, which were located on the buttocks and hips against the background of multiple scars from the resolved furuncles. In the laboratory examination, only the fact that the child is a carrier of St. Aureus in the nasopharynx. In this case, the growth of the colonies of the pathogen on nutrient media was of a "draining" nature. Polyantibiotic resistance of microorganisms to many antistaphylococcal antibiotics (including cefotaxime - 16 mm growth retardation zone, gentamycin - 14 mm growth retardation zone) has been noted. Meanwhile, a sufficient sensitivity of staphylococcus was determined to a number of antibiotics. Among them: oxacillin (zone of growth retardation 26 mm), erythromycin (growth retardation zone 30 mm), etc.
The patient underwent outpatient treatment for 6 days. Treatment included local treatment of furuncles and sanation of the nasopharynx. Locally used Vishnevsky ointment (compresses). There were no surgical interventions, as all boils at the time of primary treatment were in the infiltration phase.
The sanation of the nasopharynx was carried out with the intranasal ointment "Bactroban" and the antibiotic oxacillin. Ointment 3 times a day was inserted into each nasal passage to a depth of at least 2.5 cm. Oxacillin was administered parenterally at a dose of 150 mg / kg / day. This preparation, possessing sufficient in vitro activity, in addition to the ointment was assigned in order to increase the likelihood of complete sanation of the oropharyngeal structures, since these structures were not treated with ointment because of the extremely pronounced emetic reflex in the patient. Other medicines have not been used. Throughout the treatment period, new furuncles did not appear. Control bacteriological examination of the nasopharynx at the end of treatment: there is no growth of pathogenic microflora. This examination (collection of material) was carried out 2 days after the end of treatment.
The nearest (3 months) and distant (more than 1.5 years) treatment results were tracked: there were no boils, control bacteriological studies of nasopharyngeal mucosa - pathogenic microflora there.
Example 2
Patient X., 40 years old, was ill with furunculosis for 1.5 years. Localization of furuncles: neck, forearm, hips. The interval between the appearance of new furuncles is from 1 to 6 days. She was repeatedly examined and treated in various medical institutions where various, empirically selected antibiotics with antistaphylococcal activity (cefotaxime, gentamicin, cefazolin, ciprofloxacin, vancomycin, etc.), immunomodulators (timolin), and multivitamins were prescribed, and extracorporeal methods of detoxification and hyperbaric oxygenation were used. In addition, blood transfusion and transfusion of antistaphylococcal plasma were carried out. This treatment did not even lead to a short-term remission of the disease.
At our examination, 7 furuncles of different degree of maturity were found in the patient, which were located on the neck, forearms and hips against the background of multiple scars from the resolved furuncles. In the laboratory examination, only the fact that the patient is a carrier of St. Aureus in the nasopharynx. At the same time on nutrient media, the colonies of the pathogen were isolated.
Antibiotic resistance of microorganisms to antibiotics of different groups was noted: to cefotaxime, gentamicin, cefazolinum, cefuroxime, oxacillin, ciprofloxacin, azithromycin, rifampicin, levomycitin, doxycycline and vancomycin. The causative agent was not identified from the dissected furuncles.
The sanation of the nasopharynx was carried out with intranasal ointment "Bactroban." Ointment 2 times a day was laid in each nasal passage to a depth of at least 3 cm. The same ointment 2 times a day was treated and the available structures of the oropharynx (zev, tonsils, posterior surface of the upper 2/3 throat). Other medicines have not been used. Throughout the treatment period, new furuncles did not appear. Control bacteriological examination of the nasopharynx on the termination of treatment: there is no growth of pathogenic microflora. This examination (collection of material) was carried out 2 days after the end of treatment.
Followed (3 months) and distant (more than 1 year) results of treatment: there were no boils, control bacteriological studies of nasopharyngeal mucosa - pathogenic microflora there.
Example 3
The patient S., 36 years old, suffered from furunculosis about 1 year. Localization of furuncles: forelegs, back, hips. The interval between the appearance of new furuncles is from 1 to 3 weeks. Concomitant disease: diabetes mellitus, type II, moderate severity. The patient was repeatedly examined and treated in various medical institutions where various, empirically selected antibiotics with antistaphylococcal activity (cefotaxime, cefazolin, ciprofloxacin, vancomycin), immunomodulators, biostimulants, multivitamins were prescribed, and various extracorporeal methods of detoxification (UFO of blood, plasmapheresis) and hyperbaric Oxygenation. In addition, the antistaphylococcal plasma was poured. The patient received insulin Actrapid in a daily dose of 42 units. At the same time, the blood glucose was 5.6-6.3 mmol / l.
At our examination, the patient was found 9 furuncles of varying degrees of maturity, which were located in the area of the forearms, back and hips against the background of multiple scars from the resolved furuncles. At laboratory inspection it was revealed that the patient is a carrier of St. Aureus in the nasopharynx. At the same time on nutrient media (in vitro) the colonies of the pathogen were isolated. Antibiotic resistance to antibiotics of different groups was noted: to cefotaxime, cefazolin, ciprofloxatin, vancomycin, oxacillin. Meanwhile, moderate sensitivity of staphylococcus to gentamicin was noted (the index of the growth retardation zone is 17 mm). The causative agent from the opened furuncles could not be identified.
The patient underwent outpatient treatment for 10 days. Treatment included a sanation of the nasopharynx and insulin therapy. Local effects on boils were as follows. "Ripe" furuncles were dissected, sanitized and later on the wounds were applied to the ointments, respectively, the phase of the wound process (5% dioxin, "Solcoseryl"). On the "unripe" boils were applied compresses with ointment Vishnevsky.
The sanation of the nasopharynx was carried out by parenteral administration of gentamicin at a dose of 100 mg / kg / day.
Insulin therapy was carried out with insulin Actrapid in a daily dose of 42 units. During the first 7 days of treatment, new furuncles appeared. A control bacteriological examination of the nasopharyngeal mucosa at day 5 showed the continuing presence of St. Aureus. In this regard, from 7 days of treatment the dose is increased. From 8 days and in the subsequent new furuncles did not appear. Control bacteriological examination of the nasopharynx at the end of treatment: there is no growth of pathogenic microflora. This examination (collection of material) was carried out 2 days after the end of treatment, i.e. For 12 days. In this, the glucose value in this period was 6.1 mmol / l.
The nearest (3 months) and distant (more than 3 years) treatment results were tracked: there were no boils, bacteriological control of the mucus of the nasopharynx - a pathogenic microflora there. For the indicated period of observation, the blood glucose was periodically significantly elevated: up to 12 mmol / l.
CLAIM
1. A method for treating furunculosis, characterized in that the patient from all parts of the nasal passage, starting from the distal one, takes mucus, smears from tonsils and pharynx, carries out a bacteriological study and in the presence of nasopharyngeal carriage. Aureus completely sanitize the nasal passages, tonsils and pharynx with antibacterial agents until negative control of bacteriological examination.
2. A method according to claim 1, characterized in that as an antibacterial agent, a 2% "Bactroban" ointment is used 2-3 times per day
3. The method of claim 1, wherein antibacterial agents sensitive to St. Aureus.
print version
Date of publication 01.04.2007гг
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