Science Articles

Acute intestinal infections of any genesis including bacterial food poisoning, diarrhea syndrome of non-infectious origin and dysbacteriosis (as a part of a comprehensive therapy)

(R.V. Popova et al. 2018) conducted an assessment of extraintestinal manifestations of the norovirus infection among children. The study included 80 children hospitalized in the pediatric infectious disease unit. Norovirus etiology was confirmed via polymerase chain reaction (PCR) method. The authors assessed clinical symptomatology, laboratory examination results, ECG, echocardiography (EchoCG), ultrasonic investigation (ultrasonography) of the abdominal organs and kidneys. The most prevalent of the observed extraintestinal clinical manifestations (34% of patients) is rhinopharyngitis. According to the ECG and EchoCG results, abnormalities were found in 71% of children, changes in pancreas in 53%, changes of liver in 46%, and changes in kidneys in 38%. Extraintestinal symptoms of the majority of patients were alleviated within 18-25 days. However, the ECG and EchoCG of 2 children still showed said abnormalities, 8 children (19%) still had pancreas swelling, 11 children (29%) had abnormalities of their parenchyma and 6 children (16%) had hepatomegaly. The authors concluded that typical gastrointestinal symptoms of a norovirus infection in children are in many cases followed by the signs of disturbance to the hepatobiliary system, pancreas, upper respiratory tract, kidneys and heart in the infection-inflammatory process. Active and prompt comprehensive therapy lowers the frequency of development, longevity and severity of the major symptoms extraintestinal manifestations. The authors concluded that the most efficient medicine for treatment of a norovirus infection was colloidal silicon dioxide (Polisorb MP). 

L.V. Belokonova et al. (2017) investigated the efficiency of modern enterosorbent treatment of moderate rotavirus gastroenteritis in children. The study included 120 children, aged between 0-5 years. All patients were receiving background therapy as part of the standards for providing specialized medical care that included a balanced diet, rehydration therapy, enzyme preparations and probiotics; symptomatic therapy was performed as clinically indicated. Patients of the first group (n = 40) were receiving Polisorb MP enterosorbent in addition to the background therapy in doses based on their age. The patients received treatment for 5 days. Patients of the second group (n = 40) were receiving dioctahedral smectite in addition to the background therapy, and patients of the third group (n = 40) were receiving activated carbon. All patients were examined in accordance with the standards for providing specialized medical care to patients. Laboratory tests included a complete blood test, a clinical urine test, a stool test, a bacteriological stool test for the presence of coliform bacteria, campilobacteriosis, typho-paratyphoid group and coprofiltrate examination for the presence of rotavirus antigen in an AIE reaction. Re-examination of coprofiltrate for rotaviruses was performed on the 4th – 5th day from the beginning of treatment. If the AIE result was positive upon re-examination, it was recommended to extend the course of administration of Polisorb MP for 5 more days with a subsequent verifying detection of a rotavirus antigen in fecal matter 5 days after the patient had been dismissed.

Therapy efficiency was assessed by the length of the acuity of a disease: time of alleviation of fever, intoxication, end of vomiting, diarrhea and tympanites (Table 2).

Table 1 Average length of clinical symptoms depending on the received therapy among children with moderate rotavirus gastroenteritis 

Clinical symptom

First group

Second group

Third group

Fatigue

2.34 ± 0.153

2.28 ± 0.193

2.95 ± 0.21,2

Reduced

appetite

2.22 ± 0.113

1.90 ± 0.173

3.10 ± 0.221,2

Vomiting

1.68 ± 0.223

1.54 ± 0.153

2.65 ± 0.21,2

Tympanites

2.35 ± 0.113

2.23 ± 0.143

3.12 ± 0.11,2

Fever

2.56 ± 0.263

2.40 ± 0.143

3.35 ± 0.151,2

Diarrhea

syndrome

2.88 ± 0.173

2.80 ± 0.193

3.85 ± 0.141,2


Note: superscript is used to show groups, differences between which are statistically significant (p < 0.05).


Thus, the inclusion of Polisorb MP enterosorbents or dioctahedral smectite in the background therapy had a quicker and more prominent detoxifying, hypothermal and antidiarrheal clinical effect than when using activated carbon (p < 0.05 in each case).

With the use of Polisorb MP, the rotavirus antigen was detected in coprofiltrate on the 4th-5th day in 45% of the patients, in second group on the 4th-5th day coprofiltrate test results were positive in 40% of the patients, in the third group - in 65% of the patients. 9 convalescents who continued ingesting Polisorb MP were examined 5 days after dismissal, as well as 8 convalescents who were administered dioctahedral smectite and 10 children who were ingesting activated carbon. 1 convalescent from the first group, 1 from the second and 6 convalescents who were ingesting activated carbon had shown positive EIA results. Thus, no statistically significant differences in the sanitizing effect of Polisorb MP and dioctahedral smectite when treating rotavirus infections were detected (p > 0.05). After the dismissal of children that had a rotavirus gastroenteritis from hospital, part of convalescents continued to emit rotaviruses in the atmosphere creating a big epidemiological risk despite their clinical recovery and stool improvement. That is why using Polisorb MP as part of the comprehensive therapy of a rotavirus infection in children significantly reduces the time required for virus elimination with bowel movement and consequently reduces the number of rotavirus carriers among convalescents, thus improving the epidemiological situation within child groups.

E.V. Diachuk  et al. (2011) performed a clinical assessment of the efficiency of Polisorb MP in a comprehensive therapy. The study included 97 patients hospitalized with acute intestinal infections, aged between 18 and 84 years. The majority of patients were hospitalized during the first three days of the disease. The predominant forms of disease among the patients were moderate and severe – in 52 patients (53.6%), while a mild form was registered in 45 patients (46.4%). The patients were monitored on a daily basis from the moment of hospitalization and until their dismissal. Moreover, general clinical studies, coprological and bacteriological examinations, serum diagnosis (reaction of indirect hemagglutination with salmonella and dysentery antigens) were performed for all patients. Etiological interpretation of the diagnosis was performed in 16.5% of the cases. The predominant diagnosis among the confirmed cases was salmonellosis caused by Salmonella enteritidis – in 43.75% of the cases. Intestinal infections of an unknown origin were detected in 81 patients (83.5% of the cases). The patients were randomized into 2 groups. The main group A included 42 patients who, along with casual therapy (33 of them were receiving only casual treatment), were receiving Polisorb MP in the clinical dose of 100-200 mg/kg of the body mass per day (average dosage - 2 grams, 4 times a day) as part of complex pathogenic therapy (detoxification and rehydration therapy, enzyme preparations, pre- and probiotics). The prescribed medicine intake period was 2 to 7 days (3-5 days on average). The control group B included 52 patients, medical treatment of whom included both casual (n = 43) and pathogenic therapies excluding enterosorbents.

Pathological foreign substances were detected in stools of patients of both groups at an identical rate (16% in group A and 17% in group B). 24 patients of the treatment group and 26 patients of the control group were assigned a parenteral detoxification/rehydration therapy with consideration to the specifics of disease progression. That notwithstanding, the average period of intravenous infusions was 2.4 days in patients of both groups. The period of assigned antibacterial therapy varied from 2 to 10 days with the average result in the treatment group being 4.8 days and in the control group - 5.2 days. The authors took notice of the rapid body temperature normalization in patients of the treatment group (33 patients presented with a burning fever). When the treatment included the use of Polisorb MP, the average number of days with fever was 1.7 days as opposed to 2.3 days for the patients of the control group (40 patients presented with a burning fever). The authors also stressed quicker subsidence of gastric indigestion and more rapid stool consistency normalization in group A patients (3.9 days with diarrhea) as opposed to the index value in group B patients – 4.1 days with diarrhea. Treatment group patients stayed in the hospital for 6.7 bed-days on average while the control group patients stayed for 7.7 bed-days on average. Notably, only 2 patients out of both groups had residual effects of the disease at the time of dismissal: one patient still had a loose stool (unauthorized leave from the medical ward) and one patient still had an insignificant amount of mucus in the stool.

A.S. Vershinin et al. (2008) investigated the efficiency of the use of Polisorb MP enterosorbent in children. The study included 65 children divided into 2 groups: Study group A – 35 children who were receiving Polisorb MP enterosorbent in conjunction with traditional background therapy (including specific antibacterial and antivirus therapies), and control group B – 30 children who were receiving traditional background therapy (including specific antibacterial and antivirus therapies). Children under one year old received the study medicine in the dosage 0.3-1g/day, 1-2 years – in the dosage 1-2 g/day, 2–7 years – 2–5 g/day, 7–14 years – 5–7 g/day, over 14 years – 7–20 g/day. Ages of the children are shown in Figure 1, and etiological structure of diseases on Figure 2 .

Figure 1 Ages of the children with AII who received traditional therapy with or without Polisorb MP 

Note: group A patients (n = 35) were receiving Polisorb MP enterosorbent together with the traditional therapy while group B patients (n = 30) did not receive this medicine.


Figure 2 Etiological structure of AII in children who received traditional therapy with or without Polisorb MP 

Note: group A patients (n = 35) were receiving Polisorb MP enterosorbent together with the traditional therapy while group B patients (n = 30) did not receive this medicine.


When using Polisorb MP enterosorbent for children the authors noted short intoxication symptom alleviation time, stool normalization and disappearance of pathological foreign substances as opposed to the control group patients’ indicator values. In connection with the assigned therapy, children of the study group showed better results of intestinal debridement from infectious agents (during a rotavirus infection). Therapeutic benefit of Polisorb MP was connected to a reduction of the duration of infectious disease, hospital stay and lower cost (as compared to analogous drugs) which allowed the authors to suggest possible positive economic effects. The researchers concluded that the enterosorption method using Polisorb MP can be recommended for treating intoxication syndrome and diarrhea in children.

L.I. Ratnikova et al. (2008) investigated the efficiency of enterosorbents. The study included 88 patients with bacterial food poisoning and salmonellosis (40 females and 48 males, aged between 17 and 70 years). Depending on the treatment method, the patients were divided into 4 groups: in group I (n = 50) patients received Polisorb MP as an enterosorbent in the dosage of 9g/day; in group II (n = 14) patients received activated carbon in the dosage of 6g/day; patients of group III (n = 13) were administered Filtrum medicine in the dosage of 3.2 g/day; patients of group IV (n = 11) were not administered enterosorbents. All patients received a rehydration therapy (both infusional and oral) and polyenzymes.

Treatment efficiency was assessed by the speed of subsidence of the main disease symptoms (fever, diarrhea, vomiting). Patients of group I were prescribed 3 grams of Polisorb MP 3 times per day on the day of their admission to hospital, treatment duration was 2 to 5 days depending on the duration of diarrhea and constituted 3.78 days on average. The duration of diarrhea syndrome was 3.58 days (1 to 7 days). The duration of the fever period was 1 to 6 days and constituted 2.09 days on average. Vomiting stopped on the day of hospital admission in all cases. The average hospitalization period equaled to 6.04 days. Patients of group II received 6 grams of activated carbon as an enterosorbent per day. The duration of diarrhea in patients of group II ranged from 1 to 5 days and constituted 3.85 days on average. The duration of the fever period was 1 to 4 days and constituted 2.2 days on average. The average hospitalization period for the patients of this group equaled to 6.25 days. The patients of group III received 0.8 grams of Filtrum medicine as an enterosorbent 4 times per day for 4-5 days. The treatment was assigned upon admission to hospital (day 1-3 of the disease). The duration of diarrhea for these patients was 4.6 days, duration of the fever period – 3.5 days and average bed-days – 8.33 days. The patients of group IV (11 total: 4 females and 7 males, aged between 25 and 58 years) did not receive enterosorbents and constituted the control group. The duration of diarrhea syndrome for the patients of this group was 1 to 7 days (3.98 days on average). The duration of the fever period was 2.5 days (2 to 3 days, and in two cases no temperature rise was detected) and average hospitalization period equaled to 6.9 days (3 to 13 days).

The authors reached the conclusion that enterosorption is an efficient and necessary method of treating intestinal disturbances. Inclusion of Polisorb MP in the treatment regimen allowed for a significant reduction in the duration of fever and diarrhea as compared to the patients of the control group. Patients that received Polisorb MP recovered earlier than those who received activated carbon. Prescribing Polisorb MP allowed for a significant reduction in the duration of fever, vomiting and diarrhea while hospitalized when compared to the patients of group III. Throughout the course of this study, Filtrum medicine did not affect the infection process.

N.V. Smirnova (2007) investigated the efficiency of Polisorb MP enterosorbent in patients with infectious diseases. The study included 42 patients, aged between 18 and 55 years, diagnosed with bacterial food poisoning. The patients were divided into 3 groups: patients of the first group in addition to the standard therapy were receiving 2 grams of Polisorb MP 4 times per day, an hour before a meal for 3 days since the first day of the disease; patients of the second group were receiving standard therapy without enterosorbents and patients of the third group were receiving 2 grams of Polisorb MP 5 times per day for 3 days as part of a monotherapy regimen. Clinical efficiency of the treatment was assessed by the duration of intoxication syndrome (fatigue, headache, loss of appetite), times of temperature normalization and subsidence of diarrhea. The duration of intoxication syndrome for patients receiving Polisorb MP together with the standard therapy was 1.5± 0.6 days, their temperature normalized in 1.3± 0.5 days and stool in 1.8± 0.7 days; for Patients that did not receive Polisorb MP, the figures were 1.8± 1.5, 1.7± 0.8 and 2.3± 0.3 days respectively, and for the patients of the third group – 1.5± 0.9, 1.4± 0.3 and 1.7± 0.5 days respectively, i.e. there was no significant difference from the first group patients.

L.I. Ratnikova et al. (2011) presented an experience of using Polisorb MP in the treatment of botulism. A 45 year old patient was admitted to the infection ward on the third day of the disease with complaints of muscle fatigue, nausea, vomiting, liquid stool, visual acuity decrement, blurry vision, double vision and choking when swallowing solid food. Past history has shown that the disease started acutely, 3-4 hours after ingesting 250 ml of pickled mushrooms (of the suillus variety) that she purchased from another individual. The patient felt cold, fatigue and abdominal pain. In the following hours multiple cases of vomiting (more than 20 times in 2 days of the disease), liquid stool 6-7 times per day were added to the number of symptoms. From the first hours of the disease the patient was ingesting Polisorb MP in large doses (25 g of the medicine in 2 days) without prescription. On the second day of the disease, muscle fatigue increased, vision impairments and difficulties when swallowing solid food manifested. On the third day of the disease the patient was brought to the infection ward by an ambulance unit. Her condition upon admission was qualified as moderate. Body temperature 37.3°C, ABP – 140/90 mm HG, heart rate – 80 beats/min. and respiratory rate – 22 per minute. The neurological status revealed mydriasis, limitation of eyeball movements, weakening of accommodation, impaired convergence and choking when swallowing fluid. Clinical and epidemiological diagnosis was: “moderate botulism”.

The premorbid background in the observed case was aggravated by the consequences of multiple surgical interventions on the abdominal organs (9 abdominal operations over the past 8 years, including surgery on the esophagus). The patient was admitted to the intensive care unit, where specific therapy with anti-botulinum serum was carried out intravenously and nonspecific detoxification was performed: gastric and intestinal lavage, Polisorb MP at a dose of 9 g / day, infusion therapy with crystalloid solutions and antibacterial therapy (ciprofloxacin per os). Previous surgeries on the esophagus caused technical difficulties in conducting the probe gastric lavage. The administered therapy restored swallowing ability and removed diplopia within a day. On the third day of hospitalization, the patient retained only residual symptoms of bulbar and ophthalmoplegic syndrome. However, at the same time the patient developed laboratory signs of pyelonephritis in the form of leukocyturia of up to 50 cells in the field of vision and an increase in the level of urea and creatinine in the blood by 1.5 times (from the upper limit of the norm), which was qualified as a nonspecific complication of botulism. In the following days, a positive trend was observed. The patient was discharged on the 16th day of the disease in satisfactory condition. Blood analysis using the neutralization test did not give results, probably due to late hospitalization.

When analyzing this clinical case, the authors emphasized the relative ease of the course of the disease after a short incubation. The onset of the disease with pronounced gastroenteritis, apparently, contributed to the mechanical removal of some of the toxins from the gastrointestinal tract. The early use of the Polisorb MP enterosorbent in large doses at the pre-hospital stage also provided a detoxification effect and could affect the benign nature of the course of the disease.

A.A. Pentyuk et al. (2008) investigated the efficiency of enterosorption of Polisorb. The study included 125 patients with acute gastroenterocolitis of various etiology and severity. Results of treatment were compared between 3 groups of patients. The first group (control) consisted of 55 patients treated with traditional methods. The second group consisted of 16 patients who took white clay (comparison medicine) in addition to traditional treatment. The third group (54 people) consisted of patients who received Polisorb MP in addition to traditional treatment. All patients received antibacterial drugs in usual doses (furasolidone - 0.1 g 4 times per day; phtalazolum - 1.0 g 4 times per day; chloramphenicol - 0.5 g 4 times per day) for an average of 3-7 days. Oral rehydration was performed. With severe dehydration, fluids were administered intravenously. Gastric lavage was performed for part of the patients (9–11%) upon admission. During the entire period of treatment, patients received calcium gluconate and multivitamins. Patients from the second group, in addition to the above drugs, received white clay at a dose of 20 g 4 times per day from the day of admission. Patients of the third group were prescribed Polisorb MP at a dose of 100 mg/kg divided into 3 doses per day. The sorbent was used in the form of an aqueous suspension for no more than 3 days. Considering the severity and nosological form of intestinal infection, additional subgroups were identified in each of the groups. The diagnosis was made on the basis of bacteriological examination, clinical picture, co-program data, indirect hemagglutination reaction with the corresponding diagnosis and epidemic history. Patients, in whom the pathogen was not isolated, made up a subgroup with a diagnosis of acute gastroenterocolitis of unknown etiology with a mild or moderate course respectively. The rest had opportunistic pathogenic microflora, shigellas and salmonellas. Therapy efficiency was assessed by the rate of regression of disease symptoms.

The authors have established a high efficiency of the inclusion of Polisorb MP in the complex of treatment of patients with AEI, which manifested itself in a significant acceleration of the regression of clinical and laboratory symptoms of the disease. The inclusion of white clay in the complex of treatment of patients did not have a significant additional therapeutic effect compared to the control. On the contrary, the use of Polisorb MP as a sorbent accelerated the relief of diarrhea syndrome, in comparison with traditional therapy and treatment with white clay (for example, in patients with a mild course of undifferentiated gastroenterocolitis by 2.9 and 2.6 times, respectively), and increased the positive dynamics of other symptoms of the disease. (nausea, vomiting, intestinal pain and spasm and loss of appetite). Co-program indicators normalized significantly faster. None of the 125 patients had a bacterial carriage or chronicity of the disease. Opportunistic pathogens were isolated during the repeated examination in two of the control patients who had salmonellosis (3.6%).