Antiseptic agent Protargol nasal drops - reviews

PROTARGOL (solution) - An excellent remedy against snot of all colors of the rainbow!!!

When we were in Kislovodsk and caught snot, it quickly went away due to the local heat of 40 degrees. And a couple of weeks later, when doctors for the kindergarten began to come in at the beginning of September, they caught the snot again, sitting in hours-long queues. A little over a week of torment and here it is, salvation in the form of Protargol for ridiculous money (38 rubles). The effect of the drug became noticeable within a day or two. A prerequisite is to first clear the nose of snot; we clean it with an automatic nasal aspirator. And one more thing: the pharmacist said to put a little more than 5 drops into the syringe - the effect will be better, since in children all the evil spirits accumulate in the nasopharynx. That's what we did.

Protargol is a silver preparation that has an antiseptic, anti-inflammatory and astringent effect. The drug Protargol is widely used in the treatment of inflammatory (especially purulent) processes in ophthalmology, otorhinolaryngology, and urology. The drug Protargol is used in the treatment of various inflammatory diseases (rhinitis, pharyngitis, otitis) in children. Compared to antibiotics, taking Protargol does not lead to dysbacteriosis. The drug Protargol is available in the form of an aqueous solution.

Pharmacology

The pharmacology of the drug is explained by the proven effect of silver ions, which react with the pathogenic environment. The main idea of ​​​​using the drug is a natural antiseptic effect on the surface. Thanks to disinfection, protargol stops the spread of the inflammatory process, reducing lesions. The advantage of the drug is the absence of negative reactions from the mucous membranes and epidermis.

That is why silver ions are often used in the formulation of new forms of nasal drops and sprays used for nasal congestion. The main component is silver, which affects the DNA of pathogens and prevents pathogenic flora from multiplying, relieving symptoms. In addition, ions, reacting with proteins, create a protective layer on the inflamed areas of the mucous membranes, which removes the susceptibility of nerve fibers to the irritant and can narrow the lumen of the vascular network. Thanks to this mechanism of action, protargol relieves swelling of inflamed tissues.

How does Protargol work?

On the surface of the skin or mucous membranes damaged as a result of disease and inflammation, the drug Protargol forms a protective film (due to the precipitation of proteins with silver). Protargol reduces the sensitivity of the skin and mucous membranes, constricts blood vessels, which leads to the suppression of inflammatory reactions. Silver ions suppress the proliferation of various viruses and bacteria.

What does Protargol consist of?

The drug Protargol consists of proteins that contain silver ions (7-9%).

Indications

I use Protargol as nasal drops for:

• symptoms of acute respiratory infection;
• sinusitis;
• rhinitis;
• pharyngitis.

In addition to ARVI, protargol is indicated for patients with chronic cystitis. In urology, the solution is popular for inflammation of the bladder walls. Getting into it through a catheter, the silver solution soothes and heals the mucous membrane. The course is carried out in combination with systemic antibacterial therapy.

Conditions of use

The action of the drug involves an exclusively local effect on the lesions. The tablet form is not intended for oral administration. The contents must be crushed and dissolved in order to independently prepare a medicinal suspension. Strict adherence to proportions is mandatory: one tablet is dissolved in 10 ml of liquid supplied in the kit. The package contains a bottle that serves as a beaker.

Cooking algorithm:

1. Take the bottle.
2. Add 10 ml of solvent to it.
3. Drop 1 tablet into the solvent.
4. Close the lid and shake thoroughly until the tablet is completely dissolved.

Before using the medicine in children, it is first necessary to clear the nasal passages of dried or accumulated mucus. To do this, it is convenient to use a regular saline solution. In order for protargol to penetrate into the labyrinths of the nasal passages as far as possible, the child is placed on his back and 3-5 drops are instilled alternately into each nostril. The frequency of the procedure is twice a day.

Special instructions for the use of the drug Protargol

Before using the drug Protargol, you should consult a doctor. Only freshly prepared Protargol should be used. The drug Protargol does not affect the ability to drive a car or control various mechanisms. The drug Protargol should be stored in dark glass containers.

the medicine is excellent. shelf life is 1 month. silver does not rot or go bad, microbes are afraid of it. you can forget about throat diseases if you gargle it with a solution of 0.5 liters of water plus 0.5 ml measure protargol into a syringe. rinse 3-6 times, if there are abscesses in the throat, then add protargol 1.0 milliliter.

Dosage

Treatment of rhinitis and relief of symptoms of acute respiratory infections in children:

• instill no more than 5 drops into each nasal passage;
• the procedure is repeated morning and evening, regularly;
• Duration of treatment – ​​up to 14 days.

Treatment of conjunctival inflammation in adults:

• 2 drops of solution are applied under the lower eyelid;
• You can repeat the procedure up to 4 times a day;
• Duration of treatment – ​​up to 7 days.

If the condition of the lacrimal canals and the inner surface of the mucous membrane of the eyelids has not improved 7 days after using protargol, it is necessary to adjust the treatment by visiting your doctor.

For chronic cystitis:

• the prepared solution is injected through a catheter into the previously emptied bladder;
• refrain from urinating for 1.5-2 hours.
• repeat the procedure once a day.
• The duration of the course can vary from 7 to 14 days, depending on the patient’s symptoms.

Protargol in the treatment of rhinosinusitis in children

Introduction

Rhinosinusitis (RS) is a group of acute or chronic diseases of the nasal cavity and paranasal sinuses, during the development of which inflammation covers the paranasal sinuses (NS), spreading to the mucous membrane (MS) and submucosal layer, and in some cases to the periosteum and bone walls of the sinuses [1–4].
MS is one of the most common diagnoses in pediatric practice, but is also common in adults [5, 6]. The incidence of MS has doubled over the past 10 years, and the proportion of people hospitalized for this reason increases annually. Thus, in the USA, about 15% of the adult population suffers from various forms of the disease [7], in Russia up to 10 million people suffer from MS per year [1]. In this regard, the selection of clinically effective and safe drugs for the treatment of acute MS in children is relevant. The purpose of the work is to analyze the literature data on the use of protargol in the treatment of MS in children.

Clinic and etiology of MS

Depending on the duration of inflammation, sinusitis is classified as acute, subacute, chronic or recurrent. Acute MS usually develops as a complication of a cold, 7–10 days after the onset of an acute respiratory infection. The disease is classified as acute when the infection resolves under the influence of drug therapy, without leaving significant damage to the mucous membranes, and the duration of the disease episode does not exceed 30 days [8, 9].

The occurrence of 4 or more episodes of MS within 1 year, each of which lasts more than 7 days, with a mandatory period of complete recovery between them, indicates a relapsing course of the disease [10]. Subacute MS is said to exist if symptoms persist from 4 to 12 weeks, and chronic MS is when symptoms persist continuously for more than 12 weeks. (including those that do not respond to ongoing drug treatment). A number of authors identify latent MS, when erased clinical symptoms are revealed only during a preventive examination or the use of additional (radiation or endoscopic) diagnostic methods [11]. In terms of frequency of occurrence, the first place is occupied by pathology of the maxillary sinus and cells of the ethmoidal labyrinth, then by the frontal and sphenoid sinuses [12].

The etiological factors in the development of acute sinusitis are viruses, bacteria, fungi play an important role in the formation of the chronic process, allergic diseases in the child, the presence of structural abnormalities of the nasal passages, polyps, enlarged adenoids, living in environmentally unfavorable areas, unfavorable microclimatic conditions in the room - humidity and temperature .

The main causative agents of acute respiratory sinusitis (ARS) are respiratory viruses (rhinoviruses, respiratory syncytial viruses, adenoviruses, coronaviruses), when exposed to which the SNP is affected in almost 90% of cases. A decrease in the rate of mucociliary transport (MCT) increases the duration of contact of pathogenic bacteria with CO, which promotes bacterial infection. The main causative agents of bacterial ARS (ABRS) are Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis [11, 13]. According to foreign authors, there is an increase in the proportion of Staphylococcus aureus in the etiological structure of ABRS pathogens [14].

In recent years, cases of diagnosis of sinusitis caused by fungi have become more frequent, usually in immunocompromised patients. Aspergillus strains are most often detected, and the severity of clinical manifestations depends on the patient’s immune status.

Factors predisposing to the development of the disease include hypothermia, mechanical or chemical irritation of the mucous membrane, violations of nonspecific resistance and immunological reactivity, anatomical features of the development of the cavity and paranasal sinuses, the presence of hypertrophied adenoid vegetations, and allergies. These factors can also modify the course of acute infectious MS. The influence of the etiological agent or agents (in case of superinfection) primarily disrupts the processes of ventilation and drainage of the sinuses, which is clinically manifested by pain, increased secretion, impaired nasal breathing and olfactory function [14, 15].

Children of different age groups are characterized by different localization of the inflammatory process in the sinuses. In the first 4 years of life, the most common form of sinusitis (80–92% of all cases) is ethmoiditis. This is due to the fact that by the time the child is born, only the ethmoid labyrinth can be considered practically formed. Subsequently, only the volume of its cells increases. By the age of 4, the maxillary sinuses gradually form, so at this age the proportion of maxillary sinusitis (sinusitis) increases. The peak incidence of sinusitis occurs between the ages of 5–12 years. Due to the later formation of the frontal and main sinuses, their inflammation is possible mainly in children 5-12 years of age. After 12 years, changes can occur in any or even several SNPs [16, 17].

In general, the features of the course of MS in children include: high prevalence, especially in early childhood; same type of microflora; the occurrence or exacerbation of the disease as a complication of acute respiratory viral infection (ARVI); sudden onset, often aggressive, with a high degree of intoxication due to the rapid formation of purulent exudate; the likelihood of the process transferring to nearby organs and tissues (orbit, meninges, cellular spaces of the neck); frequent recurrence; latent course in adolescence (at least 50% of all cases) [12].

In young children, a feature is also the development of nasopharyngitis with the spread of the inflammatory process to the larynx and underlying respiratory tract (including the development of pneumonia).

Diagnosis of MS

Currently, the main problem in clinical practice is the distinction between viral and bacterial ARS. This is especially important from the point of view of the prevalence of both processes: according to modern concepts, acute purulent inflammation of the SNP occurs in 3–5% of cases, in other cases we are talking about a viral source of the disease. These data force us to take a sober approach to etiotropic treatment regimens with the prescription of antiviral or systemic antibacterial therapy (ABT). The “gold standard” for diagnosing ABRS is the isolation of bacteria in a high concentration (104 CFU/ml) from clinical material obtained from the sinus [7]. However, puncture of the SNP is an invasive and quite traumatic manipulation that must be carried out according to strict indications. Smears from the middle nasal meatus are always contaminated with the microflora of the nasal cavity, which often does not correspond to the microflora of the affected sinus (especially in the presence of a blocked anastomosis), and therefore are not suitable for microbiological diagnosis of the source of sinusitis [15, 16].

Most Russian specialists consider radiography of the ED to be mandatory to confirm the diagnosis of ABRS. However, studies have shown that in most patients with ARVI, X-ray examinations reveal changes indistinguishable from those in ABRS [1, 2, 18]. Therefore, in accordance with the international recommendations EPOS and IDSA 2012, X-ray examinations are not indicated for uncomplicated ARS [19]. Computed tomography is indicated for patients with ABRS if there is suspicion of the development of orbital and/or intracranial complications [2, 5].

General principles of treatment

Treatment of patients with MS should be comprehensive and include elimination of inflammation, restoration of patency of natural anastomoses of the urinary tract, evacuation of discharge from them, eradication of the pathogen, prevention of the development of possible complications, local immunomodulatory therapy (if indicated). In the vast majority of cases (85–90%), treatment of MS begins with the prescription of systemic antibacterial drugs (SBA). This is necessary and justified in moderate and severe MS with severe symptoms, copious amounts of pus, and general intoxication. In addition, immediate ABT should be used in young children, who quickly develop complications, as well as, regardless of age, with the development of rhinogenic complications [2, 19].

Prescribing ABP remains a controversial issue in the treatment of MS. According to studies, more than 90% of general practitioners and otolaryngologists prescribe ABPs in the presence of MS symptoms [20]. However, the widespread use of antibiotics leads to an increase in antibiotic resistance; in addition, complications of antibiotics are often observed: hepatotoxicity, allergic reactions, dysbiosis.

Along with systemic ABT, domestic otorhinolaryngologists traditionally use lavage of the nasal cavity with saline solutions, as well as local ABT and mucolytic therapy [20].

Intranasal glucocorticosteroids are recommended as a means of pathogenetic therapy, especially in patients with a history of allergic rhinitis. These drugs are used both as monotherapy for post-viral MS and in combination with systemic ABT in patients with ABRS.

In severe cases of ABRS, foreign authors recommend the use of short-course oral corticosteroids to reduce severe inflammation and pain [14], but this position is not supported by domestic guidelines [11].

In recent years, topical corticosteroid therapy for ARS has become increasingly introduced in Russia. Other methods of unloading therapy are also used, which are considered unnecessary and unreasonable according to European and American standards [14]. So, in the presence of mucopurulent discharge, puncture of the maxillary sinuses is indicated. According to domestic recommendations, evacuation of mucopurulent contents is a powerful factor in the pathogenetic treatment of acute sinusitis. However, drainage and administration of antibacterial or complex medicinal mixtures directly into the sinuses are not recommended [9, 14].

The issue of using topical ABT is controversial. In Russia, a number of drugs are traditionally used to treat ARS, which, in addition to local antibacterial ones, have anti-inflammatory and vasoconstrictor effects. Their use is not supported by the EPOS and IDSA standards. However, based on studies demonstrating the effectiveness of topical antibiotics, this group of drugs was included in domestic recommendations for the treatment of ARS [11].

Softening and liquefying viscous, thick secretions are of great importance in the treatment of sinusitis. For this purpose, solutions for rinsing the nasal cavity, as well as various mucolytic, secretomotor and secretolytic drugs can be used. The 2012 EPOS and 2012 IDSA guidelines recommend the use of irrigation therapy, as well as the secretolytic drug sinupret due to proven effectiveness, but do not recommend the use of mucolytics [19]. According to domestic authors, this position may be associated with the complexity of pharmacological assessment of the effectiveness of mucolytic drugs. Long-term observations indicating the beneficial effect of mucolytic drugs on the course of acute sinusitis, as well as research results confirming the clinical effectiveness of mucolytics, made it possible to include these drugs in domestic recommendations for the treatment of ARS [13, 20].

In children, MS is treated in a gentle manner, which eliminates the use of broad-spectrum antibiotics and glucocorticosteroids. It is rational to use local combined drops for the common cold, including framycetin, fusafungin, protargol. It is recommended to rinse the nasal sinuses with saline solutions, perform inhalations using a nebulizer, and take Borjomi water. In extreme cases, in severely advanced forms of the disease and in cases of direct danger to the child’s life, classic “adult” drugs are used, which, however, have strong side effects on the body, causing significant harm to the cardiovascular system, liver and kidneys [11].

The use of silver-based drugs in the treatment of MS

Silver-based drugs, in particular protargol, a silver proteinate, have a long history of use in MS. It is a silver-containing protein compound with antiseptic, anti-inflammatory and astringent effects [21, 22].

Protargol consists of purified water and a “silver” tablet, which should be dissolved in water. Nasal drops are an antibacterial, antiseptic, anti-inflammatory agent based on a colloidal silver solution. The validity period of the prepared product is 30 days, after which it loses its properties.

Silver proteinate is recommended for use as an antibacterial, antiseptic, anti-inflammatory agent in the form of nasal drops for rhinitis and MS; it is effective for purulent rhinitis and sinusitis. It is prescribed to children in cases where the development of a pathological process in the nasopharynx is accompanied by pharyngitis, eustachitis and MS [23].

The mechanism of action of protargol in MS is as follows. When active silver ions enter the nose, they penetrate into microorganisms, destroying their membranes and disrupting a number of vital processes. The properties of protargol have been proven to destroy both bacteria and fungal flora, and therefore children do not develop dysbiosis when using it. Previously, it was believed that protargol does not affect viruses, and therefore it is not prescribed in the acute phase of a viral infection [24]. However, when studying the effect of the solution at various concentrations on cell cultures, inhibition of the reproduction of viruses that cause infectious rhinotracheitis and viral diarrhea was noted at a concentration of 0.25–0.5% [8].

In the works of A.I. Kryukov et al. A study was conducted of the effect of local antiseptics: protargol, miramistin, chlorhexidine and photodynamic therapy on a multidrug-resistant strain of Candida tropicalis isolated from a sick child with fungal adenoiditis. The ability of antiseptics to inactivate a suspension of blastospores of a strain of the fungus Candida tropicalis (5 × 107 CFU/ml) after preliminary incubation with a solution of methylene blue at a concentration of 5 μmol/l was assessed. The authors established the minimum inhibitory concentration of antiseptics, in particular protargol, at 0.1% [25].

N. N. Zvereva recommends using local astringents containing silver proteinate at the stage of serous exudation. Currently, as the author reports, there is many years of experience in the successful use of protargol for rhinopharyngitis and MS. Unlike vasoconstrictor drops, colloidal silver acts on the etiological factor of the infectious-inflammatory process, suppressing the vital activity of infectious agents. Protargol has bacteriostatic and bactericidal effects on strains of Staphylococcus spp., Streptococcus spp., Moraxella spp. and others [1].

It is believed that, unlike ALD, protargol also has an immunomodulatory effect. It has been established that the use of protargol promotes the formation of a protective film, which is a barrier to the penetration of pathogens into the CO of the airways. Protargol is also characterized by some vasoconstrictor effect, which helps reduce swelling of the mucous membrane and nasal congestion. Signs of a decrease in the intensity of the inflammatory process have been demonstrated after the first use of this drug [6, 26].

Protargol is a kit for preparing a 2% solution of silver proteinate in a bottle. For acute rhinitis, children under 6 years old are prescribed protargol 1-2 drops 3 times a day, adults and children over 6 years old - 2-3 drops 3 times a day. In children over 6 years of age and adults, the use of a spray is permissible (1 injection 3 times a day). The duration of use for an acute process is usually 1 week, for chronic rhinitis - 14 or more days.

Among the side effects, it is necessary to note the possibility of developing allergic reactions: irritation of CO, skin itching, urticaria, atopic dermatitis, Quincke's edema, anaphylactic shock.

Thus, today there is many years of experience in the successful use of protargol for acute rhinitis in any phase of the disease - both with nasal congestion and liquid discharge, and with thick mucous discharge.

Conclusion

As an analysis of literature data shows, the problem of treating patients with acute sinusitis remains extremely relevant, which is due to the number of such patients, the complexity of diagnosis, and the prescription of adequate etiopathogenetic therapy. Modern recommendations can provide significant assistance in this regard, allowing for the correct interpretation of numerous domestic and foreign literature data.

More than half a century of experience in the use of a 2% solution of silver proteinate indicates its high effectiveness and satisfactory safety profile in the treatment of infectious and inflammatory diseases of the nasopharynx and paranasal sinuses in MS in children. At the same time, silver proteinate has not only antimicrobial, but also antiviral and immunostimulating properties. Some studies have shown that silver ions can inactivate influenza viruses, certain adenoviruses and enteroviruses. Summarizing the above, it can be argued that silver-based protargol can still be used for the treatment and prevention of these diseases in children. Rational use of this remedy allows you to quickly stop inflammation of the nasopharynx, improving the child’s well-being and reducing the risk of complications.

Additional Information

The use of protargol in ENT practice can cause darkening of the mucus discharged from the nasal passages, which is not a pathology and does not require medical intervention.

During treatment of the bladder walls with protargol, drops of blood may appear in the urine, which is explained by non-critical injury to the urethra by the catheter. Urine, when mixed with the drug, becomes dark, almost black, which is the absolute norm. Urine changes color once - only during the emptying of the bladder, after the prescribed 2 hours of abstinence after the infusion procedure.

For the treatment of bacterial infections, it is not recommended to use protargol as the main drug. Its beneficial effect is justified only as a complex therapy, simultaneously with prescribed systemic antibacterial drugs.

Side effects when using the drug Protargol

The most common side effects when using the drug Protargol include: irritation of the mucous membrane, burning sensation, itching, dry mouth, redness of the eyes, numbness, headache, dizziness, drowsiness. Rarely: urticaria, anaphylactic shock, Quincke's edema, atopic dermatitis. If you experience the above-mentioned undesirable effects when using the drug Protargol, you should consult a doctor (you may be prescribed another drug).