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34
Проблеми екологц та медицини
машки та одна чайна ложка чистотту заливають 200250 мл окропом. Розчин настояти та охолодити до 400С та за допомогою резиновоТ «грушЬ» вводиться у порожнину прямот кишки. Чоловк мае право сидiти, стояти, ходити, але не лежати. За 1 годину, а то i бь льше (в залежностi вщ реакцiТ слизовот оболонки кишки) кишка випорожнюеться i пiсля цього можна за-стосовувати ректальнi свiчки. Таку мiкроклiзму мож-ливо робити одну-двi на добу. Свiчки краще ставити не менше 2-3 разiв на добу (з метилурацилом, пропо-лiсом, анестезiном то що).
Пщнята проблема далека вiд завершення. Треба продовжувати дослщжувати та аналiзувати клУчний матерiал.
Висновки
1. Гострий простатит супроводжуеться як досить великою ктькютю Ыфекци, але i багатьма антибюти-ками до котрих вона чутлива.
2. При хрошчному простатитi визначаеться досить велика ктькють мiкст-iнфекцiТ але ктькють антибюти-кiв до котрих вона чутлива незначна.
3. Помiж шфек^ею соку та сечi мають мiсце досить значнi розбiжностi в тiм, що у простатичного соку переважае мкст-шфега^я.
4. До комплексного лкування хворих на простатит доцтьно включати фiтозбори з дотриманням необ-хiдних правил. Так фтозбори слiд змiнювати не рiдше 3-4 тижшв вiд початку застосування кожного.
Л^ература
1. Бреусов А. А., Кульчавеня Е. В. Влияние комбинированной фитотерапии на сексуальную функцию больных хроническим абактериальным простатитом / А. А. Бреусов, Е. В. Кульчавеня // Урология .- 2014.- №6.- С. 24-26.
2. Горпиченко И. И., Гурженко Ю. Н. Современный комплексный подход в лечении мужчин с эректильной дисфункцией / И. И. Горпиченко, Ю. Н. Гурженко // Здоровье мужчины.- 2015.- №2 (53).- С. 18-22.
3. Горпинченко I. I. Литвинець е. А. Сучасн пщходи та шляхи оптим1зацп л1кування хворих на хроычний простатит / I. I. Горпинченко, е. А. Литвинець // Здоровье мужчины.- 2007.- №3 (22).- С. 48-56.
4. Гурженко Ю. Н. Можливост1 впливу тамсулозину на рецидиви в ос1б з хрожчним простатитом / Ю. Н. Гурженко // Здоровье мужчины.- 2015.- №2 (53).- С. 87-90.
5. Кузнецов В. Ф., Давидов М. Н., Соколов А. П., Кузнецов С. В. Повышение эффективности и безопасности антибактериальной терапии хронического инфекционного простатита при применении БАД рекицен - РД / В. Ф. Кузнецов, М. Н. Давидов, А. П. Соколов, С. В. Кузнецов // Урология.- 2015.- №1.- С. 83-89.
6. Куцарь И. П., Сахибиазарова В. М., Швец В. Д., Крило-вская В. А. Нестандартное нетрадиционное лечение хронического простатита / И. П. Куцарь, В. М. Сахибиазарова, В. Д. Швец, В. А. Криловская // Здоровье мужчины.- 2008.- №2 (25).- С. 56-59.
7. Литвинець е. А. Застосування препарату Канефрон Н у л1куванн1 хворих на хроычний простатит / е. А. Литвинець // Здоровье мужчины.- 2007.- №3 (22).- С. 96-98.
8. Мазо Е. Б., Стеценский А. Б. Новое в фитотерапии хронического простатита / Е. Б. Мазо, А. Б. Стеценский // Здоровье мужчины.- 2004.- №3 (10).- С. 95.
9. Неймарк А. И., Неймарк Б. А., Ноздрачов Н. А. Возможности использования комплексних препаратов в лечении больных хроническим абактериальным простатитом / А. И. Неймарк, Б. А. Неймарк, Н. А. Ноздрачов // Урология. - 2014.- №6.- С. 33-37.
10. Пепенин В. Р., Пепенин С. В., Фельдман О. В. Свечи Диклоберл в терапии хронического простатита / В. Р. Пепенин, С. В Пепенин., О. В. Фельдман // Здоровье мужчины.- 2004.- №3 (10).- С. 57-60.
11. Попов С. В., Мазо Е. Б. Этиотропная терапия хронического бактериального простатита / С. В. Попов, Е.Б. Мазо // Урология .- 2008.-№3.- С. 36-41.
ENGLISH VERSION: COMPREHENSIVE TREATMENT OF PATIENTS WITH PROSTATITIS FROM THE VIEWPOINT OF MODERN REQUIREMENTS*
H.V. Bachurin
Zaporizhia State Medical University, Zaporizhia
118 patients with prostatitis were examined in our uroiogicai ciinic. 63 of them had acute prostatitis, and 55 patients -chronic prostatitis. In addition to common ciinicai examinations, bacteriological investigations were conducted to determine microorganisms in urine. Bacteriuria was revealed in 96 patients (81.3%), almost equaiiy between the monoinfection (50 patients) and mixed infection (46 patients). Besides, prostatic fluid was examined in 18 patients. It was revealed that Escherichia coi was the main source of infection, and as mono-infection it was found in 20 patients (20.7°%), and in the composition of mixed infections - in 25 cases (26.1%). The second causes of prostatitis were Staphylococcus epidermidis and hemoiyticus in 31 patients. The opportunities of drug influence on microorganisms were clearly defined. The most effective antibiotics are vancomycin, iinezoiid and cephalosporin. In order to achieve the lasting success, we offer a wide range of herbal medicines to include them in comprehensive treatment of prostatitis.
Key words: comprehensive treatment, prostatitis, antibiotics, phytotherapy.
Introduction
Acute and especially chronic inflammation of prostatic gland (prostatitis) often occur mostly in young people. In the elderly people and in children, the disease is less common. The peculiarity is that this condition causes a variety of changes in the urinary and especially genital
system. It should be noted that prostatitis can lead to the disorders of emotional state, decrease in performance efficiency, impaired sexuality, erectile function, and even infertility [1,2,4,11]. All the above leads to a number of problems, especially in the social sphere. Attempts to overcome this disease began from the moment when it was first diagnosed. The use of various drugs such as
* To cite this English version: H.V. Bachurin. Comprehensive treatment of patients with prostatitis from the viewpoint of modern requirements // Problemy ekologii ta medytsyny. - 2015. - Vol 19, № 3-4. - P. 17-22.
systemic, immunostimulatory and antiinflammatory medications provides a short-term effect. Patients keep returning to urologists for medical help.
At present the search for different antibiotics, prostate massage, physiotherapy application also do not lead to the desired result. In this regard, authors have begun to use herbal medicines in the treatment of prostatitis [3,7,8,10]. The results provide a basis for hope of a successful treatment in the nearest future. The use of herbal medicines, especially in combination of several plants (phytomixture of herbs) contributes to more effective treatment of prostatitis. Currently there is a wide variety of phytomixtures which are used in urological practice and particularly in the treatment of both acute and chronic prostatitis. The fact is that plants can be combined into phytomixtures selected for each patient individually [5,6,9].
The aim of our research is to improve the effect of treatment of prostatitis; to familiarize urologists with the possibility of using herbal medicines in combination with antibiotic therapy.
Material and methods
118 patients were monitored. The age of patients ranged from 22 to 45 years. 63 patients were hospitalized with acute prostatitis, and 55 patients - with chronic
Among 63 men with acute prostatitis, infection was found in 41 cases (65.1%). Among them, mono infection was found in 30 patients (73.2%), and mixed infection -in 11 patients (26.8%). In mono infection, E. coli was prevalent in 6 patients (20%), and hemolytic staphylo-
prostatitis. In order to determine the health status, clinical and laboratory tests were applied (complete blood count, urinalysis, blood chemistry with determining the levels of creatinine, bilirubin, electrolytes, etc.). In addition, we considered mandatory to conduct ultrasound of the genitourinary system, and make urine tests to detect infection, and its sensitivity to specific type of antibiotic. Urine culture analysis was performed in compliance with the relevant requirements of sterility, collecting the mid-portion of urine.
Results of the research
Urine culture analysis was performed in all 118 men and in 18 patients the analysis of prostatic fluid was additionally performed. In this respect, various kinds of urinary infection were found in 96 men (82.1%). "Sterile" urine was in 22 men. It should be noted that in 40 (41.6%) cases, there was a mixed infection with two or even three components (Table 1). The peculiarity consisted in the fact that the shorter the period of disease's onset was, the oftener there was a mixed infection, but there were also more antibiotics to which the sensitivity of infection was determined.
Table 1
Quantitative characteristics of microflora in patients with prostatitis
coccus - in 6 patients (20%). At the same time, in the presence of mixed infections, they also included E. coli and hemolytic staphylococcus (9 out of 11 patients). Another infection was observed in isolated cases (Table 2).
Mono-infections Mixed infections
Enterococcus faecalis 15 Enterococcus faecalis Streptococcus pneumonius 5
Ent. durans 1 Enterobacter faecalis Kl. pneumonius 1
Staphylococcus epidermidis 9 Staphylococcus epidermidis Streptococcus pneumonius 4
Esherichia coli 5 Streptococcus pyogenes Str. mitis 1
Staphylococcus haemolyticus 7 Staphylococcus epidermidis Cor. custitidis 1
Streptococcus pneumonius 4 Enterobacter aerogenosae Enterococcus faecalis 1
Ps. aerogenosae 1 Staphylococcus haemolyticus Streptococcus pneumonias 4
Streptococcus pyogenes 1 Enterococcus faecalis Ps. aerogenosae 1
St. saprophyticus 1 Enterococcus faecalis Staphylococcus haemolyticus 4
Str. agalactios 2 Streptococcus pyogenes Enterococcus faecalis 3
P. mirabilis 1 Esherichia coli Streptococcus epidermidia 1
Enterobacter agglomerans 1 Staphylococcus haemolyticus Streptococcus pyogenes 2
St. aureus 4 Esherichia coli Enterococcus faecalis 1
Kl. pneumonius 3 Enterococcus faecalis Streptococcus epidermidia 10
Str. agalactiae 1 Enterococcus faecalis Cor. amycolacum 1
Total 56 Total 40
Table 2
Characteristics of bacteriuria in patients with acute prostatitis and its sensitivity to antibiotics
Name of antibiotics Enterococcus faecalis Streptococcus pneumonius Enterobacter faecalis Kl. pneumonius Enterococcus faecalis P. mirabilis, Kl. oxyloca S. auren Staphylococcus haemolyticus Enterococcus faecalis Cor. неопределенной группы Enterobacter aerogenosae Enterococcus faecalis Staphylococcus haemolyti-cus Streptococcus pneumonias Enterococcus faecalis Staphylococcus haemolyti-cus Staphylococcus haemolyti-cus Streptococcus pyogenes Enterococcus faecalis Streptococcus epidermidia Enterococcus faecalis Cor. amycolacum Staphylococcus haemolyti-cus Streptococcus epidermidia
Vancomycin 1 2 1 2 1
Linezolid 1 2 1 1 2
Furagin 1 1 2 1 1 3 1
Moxifloxacin
Gentamicin 1 1 1
Amikacin 1
Tigecycline 1
Lincomycin 1 2 1 1 2 3 1 1
Gatifloxacin
Azithromycin 1 1 1 1 1 1
Ciprofloxacin 1 1 1 1 1 2 1
Clarithromycin 1 1 3 1
Doxycycline 1 1 1 1
Sulbactomax 1
Rifampicin 2 1 1 1
Clindamycin 1 1 1 1 1 1
Oxacillin 2 1 1
Ofloxacin 1 1 1 2
Ceftriaxone 1 1 1
Levomycetin 1 1 1 1 1
Levoflax 1
Levofloxacin 1 2
Imipinem 1 1 1
Doripenem 1
Cefixime 1
Amoksiklav 1
Tobramycin 1
Cefazolin 1
Total 6 9 8 15 3 7 9 7 8 23 4 7
It should be noted that the influence of antibiotics was as follows: vancomycin, linezolid, furagin were effective in every five cases in the presence of E. coli as a mono infection, while chloramphenicol and levofloxacin were effective only in three cases respectively. In the presence of mixed infection involving E. coli, prioritized antibiotics were furagin (10 cases), linezolid (7 cases), vancomycin (7 cases), ciprofloxacin (8 cases), clindamycin (6 cases), while imipenem was useful in 6 cases by mono infection and only in 3 cases by mixed infection. If the mixed infection contained Staphylococcus haemolyticus, better effect was demonstrated by lincomycin (12 cases), ciprofloxacin (8 cases), chloramphenicol (5 cases).
In patients with chronic prostatitis, infection was screened in 44 cases (80%). Moreover, mono infection was diagnosed in 30 individuals (68.2%), in the form of mixed infections - in 14 patients (31.8%). E. coli as mono infection was diagnosed in 12 individuals (27.2%), along with E. coli Staphylococcus epidermidis and haemolyti-
cus it was observed in 11 patients (25%). However, it should be noted that in 8 patients mixed infection also included E.coli and Staphylococcus. Thus, the main cause of prostatitis was Gram-positive infection. Other infections were rare.
It should be noted that in the presence of mono infection, vancomycin, linezolid, furagin each in 8 patients were the most effective; lincomycin and levofloxacin in 7 patients, respectively. Ciprofloxacin and doxycycline were effective in 4 and 3 patients, respectively. Among patients with Staphylococcus epidermidis in combination with haemolyticus, lincomycin, clindamycin, imipinem, ciprofloxacin, ofloxacin were the most effective (20 cases in total). Among patients with mixed infection, these drugs were much less effective. Thus, only vancomycin was effective - in 13 cases, lincomycin - in 9 cases, linezolid - in 7 cases, furagin - in 7 cases. Such drugs as ceftriaxone, tobramycin, amoksiklav were effective in isolated cases (Table 3).
Table 3
Characteristics of bacteriuria in patients with chronic prostatitis and its sensitivity to antibiotics
Name of antibiotics Enterococcus faecalis Streptococcus pneumonius Enterococcus faecalis Streptococcus pyogenes Streptococcus epidermidia Cor. Pylorum Streptococcus pyogenes Str. mitis Staphylococcus epidermidis Cor. custitidis Staphylococcus haemolyti-cus Streptococcus pneumonias Enterococcus faecalis Staphylococcus haemolyti-cus Streptococcus pyogenes Enterococcus faecalis Esherichia coli Enterococcus faecalis Enterococcus faecalis Streptococcus epidermidia Staphylococcus haemolyti-cus Streptococcus epidermidia
Vancomycin 1 1 1 1 1 1 1 5 1
Linezolid 1 1 1 3 1
Furagin 1 1 1 2 2
Lincomycin 1 1 1 1 1 1 1 2
Gatifloxacin 1 1 1 2
Azithromycin 1 1 1 1 1
Ciprofloxacin 1 1 2 1
Clarithromycin 1 1 1 1
Doxycycline 1 1 1 2 2
Cefoperazone 1
Rifampicin 1 1 2
Meropenem 1
Clindamycin 2 1 2
Oxacillin 2 1 1 1
Ofloxacin 1 1 1 1
Ceftriaxone 1 1 1 1 1
Levomycetin 1 1 1 2
Levoflax
Levofloxacin 1 1 1 1 4
Imipinem 1
Cefepime 1
Ceftazidime 1
Ceftriaxone 1
Tobramycin 1
Amoxiclav 2 1 2
Total 9 9 7 11 7 9 5 10 29 15
Having received such a result as to infection, it was decided to check for infection in the prostatic fluid and compare it with the infection screened in the urine.
Among 96 patients, in 18 men (18.7%) the infection status of prostatic fluid was detected. In addition, several features were detected. The first one was that in mono infection, Escherichia coli was screened almost exclusively (in 4 men) and in one case Enterobacter agglom-erans was identified. The second feature was the fact that in 11 patients mixed infection was found and among them in 8 patients it included E. coli.
Mixed infection consisted of 3 or 4 bacteria (mainly streptococci and staphylococci) but only in one case, E. coli was combined with hemolytic staphylococcus. Comparing the results with urine tests, one can observe dif-
ferences, since hemolytic streptococcus in combined in urine with E. coli in more than 32%. It should be noted that among 5 patients with mono infection (E. coli) the latter was significantly influenced by furagin in 3 patients, and by ceftriaxone (2). In the latter cases, antibiotics were effective in single moments and chloramphenicol was useful only twice. However, in patients with mixed infection, a significantly different clinical picture was observed. The number of effectively used drugs was considerably increased. Thus, among 13 patients with mixed infection, ceftriaxone was successfully used (9 patients), azithromycin (6), vancomycin (6), linezolid (6), clarithromycin (6), ofloxacin (5), etc. It should be noted, however, that such an "outdated" drug as chloramphenicol was effective in 5 cases (Table 4).
Table 4
Mixed infection in the prostatic fluid and its sensitivity to antibiotics
Name of antibiotics
w w
ra m o
o « E
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° ö
ft Üo co
in
u
m c
iu
ni ly ol
o
m m
u e
e a
n .c
p in
m u e
u c c c c o ia vi
o c o
c lo rg
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LU
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WMIHO
E ^ ^ ra <u o s= a) a. ,ra
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N
a. aj
<D <2
m
m
m o
in
o <u
E S S m
ra o ^
(/) si
3 ê % u R ° 9 o
o o
ft co co
ra E
Vancomycin
Linezolid
Furagin
Gentamicin
Lincomycin
Gatifloxacin
Azithromycin
Ciprofloxacin
Clarithromycin
Doxycycline
Sulbactomax
Rifampicin
Meropenem
Clindamycin
Oxacillin
Ofloxacin
Ceftriaxone
Levomycetin
Levoflax
Levofloxacin
Imipinem
Doripenem
Cefazolin
Cefoperazone
Amoxiclav
Total
10
10
10
2
2
2
2
8
8
6
8
9
8
9
8
The ongoing research in the treatment of prostatitis led to the fact that doctors began to some purpose use natural ingredients of plant origin. Constant observation led to the conclusion that not individual plant components but their mixtures are more efficient. Currently in the world there are thousands of phytomixtures that are used in urology including the treatment of prostatitis.
Using phytomixtures mainly in the outpatient treatment of prostatitis, we selected in our view the most useful ones:
Phytomixture of herbs: Herba Hyperici 35.0 Herba Chelidonii majoris 15.0 Flores Chamomillae officinalis 35.0 Flores Tiliae cordatae 15.0
Add 2 tablespoons of mixture to 0.5 liters of boiling water in a thermos, leave for 1 hour, and then sift. Take warm half a glass in the morning and evening after meals (acute prostatitis).
Phytomixture of herbs: Folia Salviae officinalis 20.0 Herba Hyperici 20.0 Herba Equiseti arvensis 20.0 Radix Petroselini sativi 20.0 Cortex fructus Phaseoli vulgaris 20.0 Add 1 tablespoon of phytomixture to a glass of cold water, leave for 6 hours, boil for 5-7 minutes, sift, take 1 glass per day.
Phytomixture of herbs: Folia Betulae pendulae 10.0
Folia Vaccinii vitis-idaea. 10.0 Herba Equiseti arvensis 10.0 Radix Valerianae officinalis 10.0 Radix Apii graveolentis 10.0
Add 2 tablespoons of phytomixture to 300 ml of boiling water, boil on water-bath for 10 min, sift. Take warm %-1/2 glass 3 times a day, 1 hour before meal.
Phytomixture of herbs: Folia Tussilaginis farfarae 15.0 Folia Plantaginis majoris 35.0 Flores Chamomillae officinalis 35.0 Herba Chelidonii majoris 15.0 Flores Tiliae cordatae 15.0
Add 2 tablespoons of the phytomixture to 0.5 liters of boiling water in a thermos, leave for 1 hour, sift. Take warm half a glass in the morning and evening after meals.
In many patients prostatitis is accompanied by inflammation of the urethra, thus it is necessary to apply herb of heartsease (Viola tricolor) 15.0. Add herb of heartsease to 200 ml of boiling water in a thermos, leave for 6 hours. Take 1 tablespoon 3 times a day after meals. Phytomixture: Herba Polygoni avicularis 50.0 Herba Equiseti arvensis 25.0
Add 1 tablespoon of the phytomixture to a glass of cold water, leave for 6 hours, boil for 5-7 minutes, sift. Take 1 glass per day.
In our opinion, administering phytomixtures in the form of microclysters is more efficient. Clinical manifestations of acute prostatitis improve after 2-3 days of treatment. Upon the analysis of relevant literature, we concluded that the following use of microclysters is the most effective: one teaspoon of dry chamomile and one teaspoon of celandine are added to 200-250 ml of boiling water. The solution is left and cooled to 400C, then using a rubber enema it is administered into the cavity of the rectum. The patient can be seated, can stand, walk, but must not lie down. Within 1 hour, or even more (depending on the response of mucosa) the intestine is emptied and thereafter you can apply rectal suppositories. Such microclysters can be applied once or twice a day. It is better to apply suppositories at least 2-3 times a day (with methyluracil, propolis, anesthesin, etc.).
The issued discussed is far from being over. It is necessary to continue to explore and analyze the clinical material.
Conclusions.
1. Acute prostatitis is accompanied by a sufficiently large number of infections, as well as many antibiotics to which they are sensitive.
2. In chronic prostatitis, quite a number of mixed infections are determined, however, the amount of antibiotics to which they are sensitive is negligible.
3. There are very significant differences between infection in fluid and urine which consist in the fact that mixed infection prevails in the prostatic fluid.
4. It is appropriate to include phytomixtures into the comprehensive treatment of prostatitis in compliance with necessary regulations. Hence, phytomixtures should be changed at least every 3-4 weeks from the beginning of each application.
References
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9. Neymark A. I., Neymark B. A., Nozdrachov N. A. Voz-mozhnosti ispol'zovaniya kompleksnikh preparatov v lechenii bol'nykh khronicheskim abakterial'nym prostatitom / A. I. Neymark, B. A. Neymark, N. A. Nozdrachov // Urologiya. - 2014.- №6.- S. 33-37.
10. Pepenin V. R., Pepenin S. V., Fel'dman O. V. Svechi Dik-loberl v terapii khronicheskogo prostatita / V. R. Pepenin, S. V Pepenin., O. V. Fel'dman // Zdorov'ye muzhchiny.-2004.- №3 (10).- S. 57-60.
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MaTepian HagitiuooB go pegamíf 18.11.2015
