Application of bacteriophage in complex treatment of rinosinusites

Abstract

Materials and methods: Sixty patients aged 18 to 85 years who were ill with acute bacterial rhinosinusitis were examined. the average age of which was 36 ± 2 years. The research was carried out on the basis of the ENT Department of the City Clinical Emergency Hospital and the Municipal Medical Diagnostic Center of the city of Vinnitsya. All patients were divided into two groups. 30 patients with acute bacterial rhinosinusitis included in the baseline therapy group 1 (group of comparison), which included: systemic antibiotic therapy (selective drugs - cephalosporins II-III generation), anti-inflammatory (topical corticosteroids, non-steroidal anti-inflammatory drugs), irrigation therapy, local decongestants and drugs with mucolytic, secretomotor and secretory effect. Group 2 (main group) consisted of 30 patients with a diagnosis of acute bacterial rhinosinusitis, the bacteriophage (sta- phylococcal or piophage) was added to the baseline therapy. Patients undergoing bacteriophage (staphylococcus or piophage) were injected as drops in the nose, 3-4 drops in each nasal passage three times a day for 7-10 days or after catheterization of the nasal sinus was washed with sterile 0.9% sodium chloride solution, after which was injected through a catheter of 3-5 ml of a bacteriophage into the sinus cavity once a day for 7-10 days. The level of secretory immunoglobulin A (sIgA) was determined using an enzyme-linked immunosorbent assay in nasal secret. The statistical processing of the results was carried out using the statistical computer program Statistica for Windows, v.12 using parametric and nonparametric methods for evaluating the results. Results: Prior to the median treatment, the concentration of sIgA in nasal washes in group 1 was 0.92 mg / L, the interquartile interval of P25-P75 was in the range of 0.74; 1.15 mg / l, and in group 2 - median 0.94 mg / L, P25-P75 - 0.75-1.10 mg / l (p> 0.05). It was found that standard therapy was accompanied by a probable increase The concentration of sIgA in the nasal secret in 7-10 days from the beginning of treatment was 2.1 times (p <0.001), compared to the indicator before treatment, while the rates before treatment and after 12 weeks were not statistically significantly different (p = 0.051). Against the background of combination therapy, which included a bacteriophage, there was a more pronounced increase in the level of sIgA - after 7-10 days in 3 times (p <0,001), in 12 weeks in 2,5 times (p <0,001), compared with the indicator before treatment. A comparison of the mean values of sIgA concentration in the nasal secret between the study groups revealed that in 7-10 days and 12 weeks, the concentration of sIgA in patients receiving a bacteriophage was 21.3% and 43.9% higher, respectively, than in patients in the base group therapy (p = 0.048 and p <0.001). It was established that modified therapy with the use of bacteriophage contributes to the prevention of chronic acute bacterial rhinosinusitis, which was 36.6% less frequent than in the basic therapy group without bacteriophage (CS: 0.18; 95% CI: [0.05-0, 58]).