The feasibility of immunocorrective therapy in the treatment of children with new tuberculosis cases

Authors

DOI:

https://doi.org/10.14739/2310-1210.2022.5.256227

Keywords:

children, tuberculosis, complex treatment

Abstract

Aim. To substantiate the expediency of the immunocorrective therapy use in combined treatment by studying the effectiveness of the immunomodulator azoximer bromide aimed at correcting the immunological changes in children with new tuberculosis (TB) cases.

Materials and methods. The study on the effectiveness of immunocorrective therapy in the complex treatment of children with new TB cases was conducted at the beginning of antimycobacterial therapy (AMBT) and at the end of the maintenance phase (MF) of AMBT. For this purpose, 51 children with new TB cases and immunologic changes were included in the study and divided into 2 groups: 26 children received immunomodulator azoximer bromide in the combined therapy on the background of AMBT (main group) and 25 children were assigned to receive only AMBT (control group). The groups were identical in age, sex, prescribed AMBT regimens, and severity of the specific process. The children from the main group along with the standard AMBT additionally used azoximer bromide (immunomodulator) to correct immunological changes: for children under 10 years of age – 6 mg twice a day, for children over 10 years – 12 mg twice a day; the treatment course – 14 days. The study results were processed on a personal computer using the statistical package of the licensed program Statistica, version 13 (Copyright 1984–2018 TIBCO Software Inc. All rights reserved, License No. JPZ804I382130ARCN10-J).

Results. Given the results obtained, the use of immunomodulator azoximer bromide in the complex treatment for children with new TB cases, alongside normalization of all cytokine profile indicators and the balance in the regulatory system of pro- and anti-inflammatory cytokines, helped to achieve by the end of treatment: a shorter average time to culture conversion by 0.9 (1.5 (1.0; 2.0) months against 2.4 (2.0; 3.0) months; P < 0.01), positive radiological dynamics of 77 % (χ2 = 5.79; P < 0.01), reduced time of destruction healing by 2.1 (1.7 (1.0; 2.0) months against 3.8 (3.0; 4.0) months, P < 0.02), shorter average time of the basic AMBT course by 1.5 (6.2 (5.6; 6.8) months against 7.7 (6.0; 9.3) months; P < 0.01). Combined treatment tolerability was satisfactory in all 100 % of cases.

Conclusions. Immunomodulator azoximer bromide as a part of the combined therapy for children with new TB cases can not only restore the body immune reactivity, but also reduce the specific process activity on the background of AMBT, shorten the average time to culture conversion by 0.9 months and destruction healing by 2.1 months, reduce the average duration of the main AMBT course by 1.5 months. In addition, this approach to therapy helps to conduct standard AMBT without changing the treatment regimen.

Author Biographies

Yu. V. Myronchuk, Zaporizhzhia State Medical University, Ukraine

асистент каф. фтизіатрії та пульмонології

O. M. Raznatovska, Zaporizhzhia State Medical University, Ukraine

MD, Assistant of the Department of Phthisiology and Pulmonology

References

Bakker, M., & Wicherts, J. M. (2014). Outlier removal, sum scores, and the inflation of the Type I error rate in independent samples t tests: the power of alternatives and recommendations. Psychological methods, 19(3), 409-427. https://doi.org/10.1037/met0000014

Bishara, A. J., & Hittner, J. B. (2012). Testing the significance of a correlation with nonnormal data: comparison of Pearson, Spearman, transformation, and resampling approaches. Psychological methods, 17(3), 399-417. https://doi.org/10.1037/a0028087

Le Boedec, K. (2016). Sensitivity and specificity of normality tests and consequences on reference interval accuracy at small sample size: a computer-simulation study. Veterinary clinical pathology, 45(4), 648-656. https://doi.org/10.1111/vcp.12390

Mironchuk Yu. V. & Raznatovska O. M. (2022). The effect of immunomodulator azoximer bromide on the cytokine profile in a complex therapy for children with newly diagnosed tuberculosis. Zaporozhye Medical Journal, 24(2), 187-190. https://doi.org/10.14739/2310-1210.2022.2.249347

Getahun, H., Sculier, D., Sismanidis, C., Grzemska, M., & Raviglione, M. (2012). Prevention, diagnosis, and treatment of tuberculosis in children and mothers: evidence for action for maternal, neonatal, and child health services. The Journal of infectious diseases, 205 Suppl 2, S216-S227. https://doi.org/10.1093/infdis/jis009

Diallo, T., Adjobimey, M., Ruslami, R., Trajman, A., Sow, O., Obeng Baah, J., Marks, G. B., Long, R., Elwood, K., Zielinski, D., Gninafon, M., Wulandari, D. A., Apriani, L., Valiquette, C., Fregonese, F., Hornby, K., Li, P. Z., Hill, P. C., Schwartzman, K., Benedetti, A., … Menzies, D. (2018). Safety and Side Effects of Rifampin versus Isoniazid in Children. The New England journal of medicine, 379(5), 454-463. https://doi.org/10.1056/NEJMoa1714284

The Sentinel Project on Pediatric Drug-Resistant Tuberculosis c/o the Department of Global Health and Social Medicine Harvard Medical School. (2018). USA: Boston. www.sentinel-project.org

Vetter T. R. (2017). Descriptive Statistics: Reporting the Answers to the 5 Basic Questions of Who, What, Why, When, Where, and a Sixth, So What?. Anesthesia and analgesia, 125(5), 1797-1802. https://doi.org/10.1213/ANE.0000000000002471

WHO. (2015). Implementing the End TB Strategy: the essentials (WHO/HTM/TB/2015.31). Geneva: World Health Organization. http://www.who.int/tb/publications/2015/end_tb_essential.pdf (https://apps.who.int/iris/bitstream/handle/10665/206499/9789241509930_eng.pdf)

WHO. (2019). Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. Geneva: World Health Organization, 64. https://apps.who.int/iris/handle/10665/260233

Ilinska, I. F. (2010). Varianty vtorynnoi imunolohichnoi nedostatnosti, yikh diahnostychni kryterii ta pryntsypy imunokorektsii (analitychnyi ohliad) [Variants of secondary immunological insufficiency, their diagnostic criteria and principles of immunocorrection (analytical review)]. Laboratory diagnostics, 4, 17-23. [in Ukrainian].

Raznatovska, O. M. (2015). Dynamika pokaznykiv tsytokinovoho profiliu pid vplyvom imunomoduliatora hlutamin-tsystynil-hlitsyn dynatriia u khvorykh na destruktyvnyi multyrezystentnyi tuberkuloz lehen [Dynamics of cytokine profile parameters under the influence of the immunomodulator glutamine-cystinyl-glycine disodium in patients with destructive multidrug-resistant pulmonary tuberculosis]. Zaporozhye Medical Journal, (3), 95-98. [in Ukrainian]. https://doi.org/10.14739/2310-1210.2015.3.44508

Ministry of Health of Ukraine. (2021, October 6). Standarty okhorony zdorovia pry tuberkulozi: nakaz MOZ Ukrainy vid 06.10.2021 r. No. 2161 [Standards of health care in tuberculosis No. 2161]. [in Ukrainian]. https://www.dec.gov.ua/wp-content/uploads/2021/10/2020_530_standarty_tb_dor_dit.pdf

Ministry of Health of Ukraine. (2021). Tuberkuloz. Klinichna nastanova, zasnovana na dokazovykh danykh [Tuberculosis. Evidence-based clinical guidelines]. Health Center of the Ministry of Health of Ukraine. [in Ukrainian]. https://www.dec.gov.ua/wp-content/uploads/2021/11/2021_11_18_kn_tuberkuloz.pdf

Shalmin, A. S., & Raznatovskaya, E. N. (2015). Efektyvnist zastosuvannia imunomoduliatora hlutamin-tsystynil-hlitsyn dynatriia u kompleksnomu likuvanni khvoryh na destruktyvnyi multyrezystentnyi tuberkuloz lehen [Efficacy of glutamine-cystinyl-glycine disodium immunomodulator use in complex treatment of patients with destructive multidrug-resistant pulmonary tuberculosis]. Current issues in pharmacy and medicine: science and practice, (2), 71-74. [in Ukrainian]. https://doi.org/10.14739/2409-2932.2015.2.45196

Downloads

Published

2022-10-22

How to Cite

1.
Myronchuk YV, Raznatovska OM. The feasibility of immunocorrective therapy in the treatment of children with new tuberculosis cases. Zaporozhye Medical Journal [Internet]. 2022Oct.22 [cited 2024Jul.3];24(5):556-9. Available from: http://zmj.zsmu.edu.ua/article/view/256227

Issue

Section

Original research