Science Articles

Some features of the treatment of acute intestinal infections in adults and children


Acute intestinal infections (AII) with severe diarrhea syndrome constitute a significant portion of hospitalized patients with infectious diseases, which necessitates the use of enterosorbents.
The aim: to analyze the effectiveness of the use of the Polisorb MP enterosorbent (active ingredient: colloidal silicon dioxide), in comparison with other enterosorbents, as a component of the treatment of acute
intestinal infections, using the time period for eliminating pain and dyspeptic syndromes as the comparative variable.
Material and methods. 62 cases of acute intestinal infections were analyzed in the Penza Regional Clinical Center for Specialized Medical Care. The diagnosis of AII was established on the basis of anamnestic and clinical data. The diagnosis was confirmed by bacteriological inoculation of feces, by PCR for the presence of genetic material of causative agents of acute intestinal infections. Statistical processing of research materials was carried out using methods of variation statistics.
Results. The use of the Polisorb MP as part of the comprehensive therapy of acute intestinal infections agents contributes to a more rapid regression of the clinical manifestations of the disease: the pain syndrome was
stopped, on average, within 1–3 days and the dyspeptic syndrome was stopped within 1–6 days (when using another enterosorbent, from 2 to 6 days and from 2 to 7 days, respectively).
Conclusion. Enterosorbent Polisorb MP is effective in adults and children in the treatment of acute intestinal infections of various etiologies and is convenient to use and safe.
Funding. The study had no sponsor support.
Conflict of interests. The authors declare no conflict of interests.
Contribution. The concept and design of the study – Krasnova L.I., Baranova I.P., Kurmaeva D.Yu., Popilov M.A.; collection and processing of material – Krasnova L.I., Dubinovskaya E.V.; statistical processing – Dubinovskaya E.V.; writing the text – Krasnova L.I., Baranova I.P., Dubinovskaya E.V.; editing – Baranova I.P.; approval of the final version of the article – Baranova I.P., Kurmaeva D.Yu.
For citation: Krasnova L.I., Baranova I.P., Dubinovskaya E.V., Kurmayeva D.Yu., Popilov M.A. Some features of the treatment of acute intestinal infections in adults and children. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2020; 9 (4): 92–7. DOI: https://doi.org/10.33029/2305-3496-2020-9-4-92-97 (in Russian)
Received 07.10.2019. Accepted for publication 09.11.2020.

Keywords: acute intestinal infections, treatment, enterosorbents, Polisorb MP (Silicium dioxide colloidal)

Acute intestinal infections (AII) constitute a significant part of infectious pathologies and represent one of the major causes of disease and death in developed and developing countries [1, 2]. According to the official data, 754 cases of AII [3] were registered in Penza region as of February, 2019. With intestinal diseases on the rise and strengthening resilience of intestinal infections agents to antibacterial drugs. As such, using the method of enterosorption remains at the forefront of disease treatment [4]. The growth of viral intestinal infections with a pronounced diarrhea syndrome represents the facet of the issue that requires the use of enterosorbents. However, most of them have a necessary therapeutic effect only in large doses (up to 100 g/day), causing a disorder of the morphofunctional state of intestinal tract [5]. The distinctive feature of Polisorb MP is that the silicon dioxide molecule constituted in a colloidal suspension does not have a crystalline structure and does no damage to the mucous membrane of gastrointestinal tract. The drug creates a suspension and does not flake for up to 60 hours and has a high level of dispersion, which strengthens its effectiveness a hundred-fold when compared to traditional carbon sorbents. Wall effects of Polisorb MP resembling the effects of coating medications are beneficial as well. Gluing together microbial bodies, Polisorb MP blocks their vital activity showing its bacteriostatic properties. Production of the drug corresponds to the GMP standards [6].

The aim – to analyze the effectiveness of the use of the Polisorb MP enterosorbent (active ingredient: colloidal silicon dioxide), in comparison with other enterosorbents, as a component of the treatment of AII, using the time period for eliminating pain and dyspeptic syndromes as the comparative variable.

Material and methods

62 cases of the disease were analyzed. A prospective controlled clinical study was carried out in 2019 in the infection ward No. 4 located on the basis of the Penza Regional Clinical Center of Specialized Types of Medical Care. The infection ward has 43 beds and is intended primarily for the treatment of patients with acute respiratory infections in children from the age of 5 and adult patients.

AII was diagnosed on the basis of anamnestic, clinical data, as well as complaints of weakness, pain in the epigastrium and along the intestinal tract, repeated vomiting, frequent liquid stool, fever and clinical data (dehydration, intoxication, loss of appetite, vomiting, dry tongue and lips, painful palpation of the abdomen in the epigastric region and along the intestinal tract, liquid stool).

The diagnosis was confirmed by clinical analysis, biochemical blood test (possible increase of urea and creatinine with the amylase levels in the norm), clinical urine analysis (high specific gravity, presence of protein, blood corpuscles, ketones), coprological test (increased amount of neutral fat, soap, white blood cells in large quantities, mucus, erythrocytes), bacterial culture test (pathogens of bacteria of the intestinal group), inoculation of feces by polymerase chain reaction (PCR) method for the presence of genetic material of causative agents of acute intestinal infections (rotaviruses, noroviruses, astraviruses, adenoviruses, shigella, salmonella, campylobacter) using the "Screening of acute intestinal infections ... Determination of DNA (RNA) Shigella spp., E. coli (EIEC), Salmonella spp., Campylobacter spp., Adenovirus F, Rotavirus A, Norovirus 2 genotype, Astrovirus [real-time PCR] " test system; the results of ultrasound examination of the abdominal organs, kidneys and, if necessary, X-ray of the abdominal organs (in order to exclude the structural pathology of the organs of the gastrointestinal tract and acute intestinal obstruction).

Polisorb MP (active ingredient: colloidal silicon dioxide) was tested as an enterosorbent in a comprehensive therapy with the assessment of its effectiveness in AII patients as compared to other enterosorbents. The drugs were prescribed as a 6-day course in accordance with the age and weight categories of the patients.

Polisorb MP was prescribed in accordance with the instructions for use, in the form of an aqueous suspension administrated orally 3 times per day, i.e. the powder was mixed in 1/4–1/2 glass of water, depending on the body weight (Table 1).

The study included 62 patients with AII that manifested in the form of gastritis, gastroenteritis, enteritis or colitis syndromes. Gender-wise, the study included 39 females and 23 males. 32 patients were children from the age of 3 and 30 patients – adults (Tables 2 and 3).

All patients were divided into 2 groups: comprehensive therapy of the first group patients included Polisorb MP enterosorbent – 21 monitored patients; patients of the second group received another enterosorbent (activated carbon) – 41 monitored patients (Table 4).

In 11 (17.74%) patients the etiology of the disease was established bacteriologically; in 11 (17.74%) cases – using PCR diagnostics, in 40 (64.52%) cases the etiology of AII was not identified.

Statistical processing of research materials was carried out using methods of variation statistics and the determination of the reliability indicator (p <0.05).


Table 4. Etiological structure of verified acute intestinal infections (AIIs)

AII etiology

Polisorb MP

Activated carbon

Overall

Not identified

19

21

40

Staphylococcus

-

6

6

Salmonella

1

-

1

Norovirus

-

3

3

Mixed infection caused by a rotavirus or a norovirus

-

2

2

Shigella flexneri

-

3

3

Rotavirus

1

6

7

Total

21

41

62


Ingested as a water suspension an hour before or an hour after a meal and ingesting other medicaments.


Results and discussion

Assessment of the effectiveness of the use of enterosorbents with reference to the relief of pain and dyspeptic syndromes is given in Table 5. The average period of pain relief in patients with AII when using Polisorb MP was found to be 1.4 (from 1 to 3) days, when using another enterosorbent - 4.3 (from 2 to 6) days (p <0.001). The period of relief of dyspeptic syndrome exceeded the period of pain relief in both groups and averaged 2.1 (from 1 to 6) days when using Polisorb MP and 4.7 (from 2 to 7) days when using other enterosorbents (p <0.001).


Table 5. Periods of pain relief and the relief of dyspeptic syndrome in analyzed groups (the use of Polisorb MP enterosorbent, the use of another enterosorbent)

Syndrome

Period of relief of the assessed syndromes, days

p

Polisorb MP

Activated carbon (2nd group)

Pain

1.4

4.3

<0.001

Dispeptic

1.2

4.7

<0.001



According to the obtained data the administration of Polisorb MP as part of the comprehensive therapy of AIIs of various etiologies led to a rapid regression of clinical manifestations of the disease: pain and dyspeptic syndromes during therapy with Polisorb MP disappeared much faster (by more than 2 times). This contributed to the reduction in the duration of hospitalization and, consequently, disability of the population. All patients noted the acceptability of the drug and its ease of use, since Polisorb has no taste or smell and does not stain fecal matter with a dark color as charcoal does, which allows patients to better monitor their condition. Having analyzed the effectiveness of the use of the enterosorbent Polisorb MP as compared with other enterosorbents, we can assume a pronounced sorption effect of the drug, which makes it possible to recommend it to patients with AII as part of a comprehensive therapy.


Conclusion


The use of Polisorb MP as part of the comprehensive therapy of acute intestinal infections of various etiologies led to a rapid regression of pain and dyspeptic syndromes by more than 2 times, which contributed to a reduction in the duration of hospitalization and disability of the population. Polisorb MP is effective in treating AII of various etiologies in adults and children. The use of the Polisorb MP enterosorbent is safe as it has no smell and taste, which increases the adherence to the treatment of AII on the part of patients.


AUTHORS


Lydmila Ivanovna Krasnova - Candidate of Medical Sciences, Associate Professor, Senior Lecturer of the Department of Infectious Diseases of Penza Institute for Advanced Training of Doctors - branch of the FSBEI FPE RMACPE MOH Russia, Penza, Russian Federation

E-mail: lik72@list.ru

Irina Petrovna Baranova – Doctor of Medicine, Professor, Professor of the Department of Infectious Diseases of Penza Institute for Advanced Training of Doctors - branch of the FSBEI FPE RMACPE MOH Russia, Penza, Russian Federation

E-mail: irinapetrovna.baranova@yandex.ru

https://orcid.org/0000-0002-3692-8359

Elena Vladimirovna Dubinovskaya - Assistant of the Department of Infectious Diseases of Penza Institute for Advanced Training of Doctors - branch of the FSBEI FPE RMACPE MOH Russia, Penza, Russian Federation

E-mail: d.e.v.1991@yandex.ru

Dzhamilya Yusupovna Kurmaeva - Candidate of Medical Sciences, Deputy Chief Physician for the Medical Department of the State Budgetary Healthcare Institution Penza Regional Clinical Center of Specialized Medical Care, Freelance Chief Infectious Disease Specialist of the Ministry of Health of Penza Region, Penza, Russian Federation

E-mail: d.kurmaeva@yandex.ru

Mikhail Andreyevich Popilov - General Director of JSC Polisorb, Chelyabinsk Region, Kopeysk, Russian Federation

E-mail: info@polisorb.com

https://orcid.org/0000-0001-8786-8635

REFERENCES


  1. SP 3.1.1.3108-13 «Prevention of acute intestinal infections». (in
    Russian).

  2. Men’shikova S.V., Ketova G.G., Popilov M.A. Diarrhea of various etiologies. Polisorb MP as a new solution to an urgent problem. Glavniy vrach
    Yuga Rossii [Chief Physician of the South of Russia]. 2017; 3 (56): 29–34.
    (in Russian).

  3. Penza State Sanitary and Epidemiological Surveillance Center, official website. URL: http://medfirms.ru/firm41067.html

  4. Kulmagambetov I.R. Modern approaches to the control and containment of antibiotic resistance in the world. Mezhdunarodniy zhurnal prikladnikh i fundamental’nikh issledovaniy [International Journal of Applied and Fundamental Researches]. 2015; (9): 54–9. (in Russian).

  5. Men’shikova S.V., Popilov M.A., Ketova G.G. Alternative solutions to the
    pressing problems of modern medicine. Zhurnal mezhdunarodnoy meditsiny
    [Journal of International Medicine]. 2017; 1 (24): 54–8. (in Russian)

  6. Men’shikova S.V., Ketova G.G., Popilov M.A. The use of enterosorbent Polisorb MP (colloidal silicon dioxide) in the complex treatment of various pathological conditions in children. Sovremennye problemy nauki I obrazovaniya [Modern Problems of Science and Education]. 2016; (6): 184. (in Russian)