Immunomodulatory therapy for patients with infectious exacerbations of COPD as a strategy for overcoming antibiotic resistance

Background. Patients with chronic obstructive pulmonary disease experience regular exacerbations, often leading to irreversible decline in respiratory function and respiratory failure. These exacerbations are associated with increased mortality, as confirmed by multicenter studies. Bacterial infections are the primary cause of these exacerbations, and the widespread prevalence of chronic obstructive pulmonary disease poses significant clinical and socioeconomic challenges for healthcare professionals. Infectious exacerbations of chronic obstructive pulmonary disease are a serious problem in clinical practice, especially in the context of increasing antibiotic resistance. This study was aimed at evaluating the effectiveness of including immunostimulating therapy with sodium deoxyribonucleate (15 mg/ml; 1 vial intramuscularly daily for 5 days, then five injections at 48-hour intervals; a total course of 15 days, 10 injections) in standard regimens for stopping chronic obstructive pulmonary disease exacerbations (n = 60 patients). The results showed a number of significant positive therapeutic effects: the effectiveness of microbiological sanitation of the respiratory tract significantly increased (19.9%); the effect of antibacterial drugs was potentiated; a pronounced and reliable anti-inflammatory effect (p < 0.001) and a reduction in the bacterial load in the respiratory tract (from 106 CFU/ml to 5.5 × 103 CFU/ml) were noted. A clinically significant improvement in the general condition of patients was observed (oxygen saturation increased to 97% (p = 0.015), regression of leading respiratory symptoms accelerated, and macroscopic characteristics of sputum returned to normal).
Conclusion. Thus, the obtained data convincingly demonstrate the synergistic effect of the immunostimulant (sodium deoxyribonucleate, 15 mg/ml) in the combination therapy of chronic obstructive pulmonary disease. It improves microbiological outcomes and contributes to the stabilization of the disease, which is critical for improving the quality of life of patients and optimizing therapeutic strategies in pulmonology.

1. Kasumova H. M. Medical and biological problem: a new round of antibiotic resistance development in the post-COVID period. Actual problems of society, science and education, medicine and psychology in the context of global challenges: Proceedings of the International in-person and correspondence scientific and practical conference, Oryol, December 26, 2024. Oryol: Oryol State University named after I. S. Turgenev, 2025. pp. 396-409. (In Russ.)

2. Mukhitdinova M. I., Akhmedova G. Kh. Rational antibiotic therapy of bronchopulmonary diseases, prevention of antibiotic resistance. Put nauki. 2025: 4 (134): 41-44. (In Russ.)

3. WHO warns of widespread resistance to common antibiotics worldwide [Электронный ресурс]. Всемирная организация здравоохранения (ВОЗ). 13.10.2025. URL: https://www.who.int/ru/news/item/13-10-2025-who-warnsof-widespread-resistance-to-common-antibiotics-worldwide.

4. Rothnie K. J., Müllerová H., Smeeth L., et al. Natural History of Chronic Obstructive Pulmonary Disease Exacerbations in a General Practice-based Population with Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine. 2018; 4 (198): 464-471.

5. Tsepelev V. Yu., Lazareva I. A., Boldina N. V., et al. Antibiotic resistance and pharmacological approaches to overcoming it. Sovremennye problemy nauki i obrazovaniia. 2025; 2: 70. (In Russ.)

6. Bhat T. A., et al. Immune Dysfunction in Patients with Chronic Obstructive Pulmonary Disease. Annals of the American Thoracic Society. 2015.

7. Piradov M. A. Antibiotic resistance is one of the global challenges facing humanity. Vestnik Rossiiskoi akademii nauk. 2025; 4: 22-24. (In Russ.)

8. Dadonova E. D., Shelkovaya A. S., Efimova A. I., et al. Overcoming antibiotic resistance: new strategies in the treatment of infectious diseases. Klinicheskaia infektologiia i parazitologiia. 2024; 2 (13): 242-252. (In Russ.)

9. Zuikova A. A., Krasnorutskaya O. N., Kotova Yu. A., et al. Efficiency of including sodium deoxyribonucleate in the complex treatment of patients with community-acquired pneumonia. Lechaschi Vrach. 2020; 6: 80-84. (In Russ.)