Efficiency of systemic enzyme therapy in the combination treatment of pelvic inflammatory diseases in women

Kokhno N.I., Gorshkova O.V., Molodtsova L.Yu.

1) “Center for Reproduction and Genetics” LLC, Moscow, Russia; 2) Institute for Advanced Training of Healthcare Professionals, Ministry of Health of the Khabarovsk Territory, Khabarovsk, Russia; 3) “Immunorehabilitation Center” LLC, Khabarovsk, Russia
Objective: To evaluate the effect of Wobenzym included in the combination therapy of pelvic inflammatory diseases (PIDs) on the time course of changes in some clinical and laboratory parameters and on the number of relapses. Materials and methods: The results of examination and treatment were retrospectively analyzed in 118 reproductive-aged women diagnosed with PID. All the patients were divided into 2 groups: 1) 46 patients received etiotropic antibiotic therapy and probiotics; 2) 72 patients used etiotropic antibiotic therapy, probiotics, and Wobenzym that has anti-inflammatory and immunomodulatory effects. The investigators evaluated the impact of therapy on pain syndrome subjectively on the basis of the patients’ complaints and objectively during bimanual palpation on days 3, 7, 10, and 14 after the start of therapy, the time course of changes in the parameters of vaginal smear and real-time polymerase chain reaction on 14 days, and the rate of disease recurrence and menstrual disorders within 12 months after etiotropic treatment. Results: On 14 days after the start of antibiotic therapy, dysbiosis was detected in 56.5% (26/46) of cases in the patients receiving antibiotic therapy and probiotics and in 19.4% (14/72) of cases in those who additionally took Wobenzym (RR 0.34, 95% CI 0.20–0.59; p=0.0001). Within 12 months after the end of etiotropic therapy, relapses were recorded in 56.5% (26/46) of the patients who received standard therapy and in 15.3% (11/72) of those who additionally used Wobenzym (RR 0.27; 95% CI 0.15–0.49; p<0.0001). The patients taking Wobenzym were statistically significantly less likely to have menstrual irregularities within 3 to 6 months after etiotropic therapy (RR 0.17, 95% CI 0.08-0.39; p<0.0001) within 7 to 9 months (RR 0.014, 95% CI 0.0009–0.23), and within 10 to 12 months inclusive (RR 0.01, 95% CI 0.0008–0.22; p=0.003). Women who planned pregnancy and received Wobenzym were statistically significantly more likely than those with standard therapy to have spontaneous conception within 6 months after the end of etiotropic therapy (RR 0.18, 95% CI 0.07–0.45; p=0.0003). Conclusion: The use of systemic enzyme therapy with Wobenzym in the combination treatment of patients with PID improves vaginal microbiocenosis and assists in reducing disease recurrences and in restoring the reproductive health of women.


systemic enzyme therapy
pelvic inflammatory diseases
reproductive dysfunction


  1. Бебнева Т.Н., Дамиров К.Ф. Воспалительные заболевания органов малого таза. Гинекология. 2019; 21(5): 39-44. https://dx.doi.org/10.26442/20795696.2019.5.190743. [Bebneva T.N., Damirov K.F. Pelvic inflammatory disease. Gynecology. 2019; 21(5): 39-44. (in Russian)]. https://dx.doi.org/10.26442/20795696.2019.5.190743.
  2. Довлетханова Э.Р., Абакарова П.Р., Мгерян А.Н. Лечебные аспекты воспалительных заболеваний органов малого таза. Медицинский совет. 2018; 7: 40-4. [Dovletkhanova E.R., Abakarova P.R., Mgeryan A.N. Therapeutic aspects of inflammatory diseases of the pelvic organs. Medical Council. 2018; 7: 40-4. (in Russian)].
  3. Тютюнник В.Л., Вересова А.А., Сироткина Е.А., Кан Н.Е. Воспалительные заболевания органов малого таза: основные принципы терапии. Медицинский совет. 2018; 12: 160-5. [Tyutyunnik V.L., Veresova A.A., Sirotkina E.A., Kan N.E. Inflammatory diseases of the pelvic organs: basic principles of therapy. Medical Council. 2018; 12: 160-5. (in Russian)].
  4. Пестрикова Т.Ю., Юрасов И.В., Юрасова Е.А. Воспалительные заболевания органов малого таза: современные тренды диагностики и терапии (обзор литературы). Гинекология. 2018; 20(6): 35-41. [Pestrikova T.Yu., Yurasov I.V., Yurasova E.A. Inflammatory diseases of the pelvic organs: current trends in diagnosis and therapy (literature review). Gynecology. 2018; 6: 35-41. (in Russian)].
  5. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Воспалительные заболевания женских тазовых органов. M.; 2021. 46 с. [Ministry of Health of the Russian Federation. Clinical guidelines. Inflammatory diseases of the female pelvic organs. M.; 2021 46 р.(in Russian)].
  6. Дикке Г.Б. Современные методы профилактики воспалительных заболеваний органов малого таза у женщин и их осложнений. Протективный потенциал пролонгированного режима комбинированной оральной контрацепции. Акушерство и гинекология. 2017; 5: 44-9.https://dx.doi.org/10.18565/aig.2017.5.44-49. [Dicke G.B. Modern methods of prevention of inflammatory diseases of the pelvic organs in women and their complications: Protective potential of prolonged regimen of combined oral contraception. Obstetrics and Gynecology. 2017; 5: 44-9 (in Russian)].https://dx.doi.org/10.18565/aig.2017.5.44-49.
  7. Хрянин А.А. Хронические воспалительные заболевания органов малого таза – стратегия достижения длительной ремиссии и рациональный подход к терапии. Medicine (Almaty). 2017; 1: 32-40. [Khryanin А.А. Inveterate pelvic inflammatory disorders – strategy of the achievement of long-lasting remission and rational approach to therapy. Medicine (Almaty). 2017; 1(175): 32-40. (in Russian)].
  8. Скворцов В.В., Скворцова Е.М., Бангаров Р.Ю., Матвеев Н.Д. Современные представления о диагностике и лечении воспалительных заболеваний органов малого таза. Лечащий врач. 2022; 5-6: 9-13. [Skvortsov V.V., Skvortsova E.M., Bangarov R.Yu., Matveev N.D. Modern concepts of inflammatory diseases of the pelvic organs. Lechaschiy Vrach/Attending Physician. 2022; 5-6 (25): 9-13. (in Russian)].
  9. Гомберг М.А. Современные представления о лабораторной диагностике и лечении воспалительных заболеваний органов малого таза. Акушерство и гинекология. 2014; 10: 87-90. [Gomberg M.A. Modern concepts of laboratory diagnosis and the appearance of inflammatory diseases of the pelvic organs. Obstetrics and Gynecology. 2014; 10: 87-90. (in Russian)].
  10. Judlin P., Thiebaugeorges O. Levofloxacin plus metronidazole in uncomplicated pelvic inflammatory disease: A preliminary study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2009; 145(2): 177-9. https://dx.doi.org/10.1016/j.ejogrb.2009.04.025.
  11. De R., Patra K.K., Goswami A., Maiti B., Bhattacharya S. A comparison of treatment outcomes for levofloxacin versus doxycycline plus metronidazole for first-line treatment of uncomplicated pelvic inflammatory disease. Asian J. Med. Sci. 2022; 13(12): 179-84. https://dx.doi.org/10.3126/ajms.v13i12.47518.
  12. Dittmar F.-W., Weissenbacher E.R. Therapy of adnexitis - enhancement of the basic antibiotic therapy with hydrolytic enzymes. Int. J. Exp. Clin. Chemother. 1992; 5(2): 73-81.
  13. Friedrich F. Therapie der chronischen Adnexitis: Diclofenac oder Enzyme? Der Allgemeinarzt. 1993; 17: 1061-4.
  14. Сидельникова В.М., Кирющенков П.А., Ходжаева З.С., Ходжаева А.С. Применение системной энзимотерапии в акушерстве и гинекологии. Гинекология. 2003; 6: 233-8. [Sidelnikova V.M., Kiryushchenkov P.A.,Khodzhaeva Z.S., Khodzhaeva A.S. The use of systemic enzyme therapy in obstetrics and gynecology. Gynecology. 2003; 6: 233-8(in Russian)].
  15. Бельских О.Л., Коротких И.Н. Системная энзимотерапия в лечении спаек брюшной полости после реконструктивно-пластических операций на маточных трубах. Акушерство и гинекология. 2019; 12: 184-6.https://dx.doi.org/10.18565/aig.2019.12.184-186. [Belskikh O.L., Korotkikh I.N. Systemic enzyme therapy in the treatment of abdominal adhesions after reconstructive plastic surgery on the fallopian tubes. Obstetrics and Gynecology. 2019; 12: 184-6 (in Russian)]. https://dx.doi.org/10.18565/aig.2019.12.184-186.
  16. Михайлов И.Б., Стернин Ю.И. Избранные вопросы системной энзимотерапии. Архив внутренней медицины. 2012; 1(3): 15-9. [Mikhailov I.B., Sternin Yu.I. Selected issues of systemic enzyme therapy. Archive of Internal Medicine. 2012; 1(3): 15-9. (in Russian)].
  17. Кладова О.В., Харламова Ф.С., Стернин Ю.И., Фельдфикс Л.И., Учайкин В.Ф. Дисбактериоз экосистемы организма у часто болеющих детей: современные методы диагностики и лечения. Доктор.Ру 2011; 5(64): 29-34. [Kladova O.V., Kharlamova F.S., Sternin Yu.I., Fedfix L.I., Uchaikin V.F. Bacterial overgrowth in microbial ecosystem in frequently ill children: up-to-date diagnostic and treatment options. Doctor. Ru. 2011; 5(64): 29-34. (in Russian)].
  18. Государственный реестр лекарственных средств (ГРЛС МЗ РФ). Доступно по: https://grls.rosminzdrav.ru/GRLS.aspx?RegNumber=&MnnR=&lf=&TradeNmR=Вобэнзим&OwnerName=&MnfOrg=&MnfOrgCountry=&isfs=0&regtype=1%2c6&pageSize=10&order=RegDate&orderType=desc&pageNum=1 [State Register of Medicines. URL: https://grls.rosminzdrav.ru/GRLS.aspx?RegNumber=&MnnR=&lf=&TradeNmR=Вобэнзим&OwnerName=&MnfOrg=&MnfOrgCountry=&isfs=0&regtype=1%2c6&pageSize=10&order=RegDate&orderType=desc&pageNum=1 (in Russian)].
  19. Горшкова О.В., Чижова Г.В., Молодцова Л.Ю., Морозов О.Н. Пути оптимизации лечения вагинальных инфекций в амбулаторных условиях. Медицинский совет. 2018; 13: 130-4. [Gorshkova O.V., Chizhova G.V., Molodtsova L.Yu. Ways to optimize the treatment of vaginal infections on an outpatient basis. Medical Council. 2018; 13: 130-4 (in Russian)].
  20. Ордиянц И.М., Коган Е.А., Барабашева С.С. Саногенез против патогенеза. StatusPraesens. Гинекология, акушерство, бесплодный брак. 2018; 6: 79-83. [Ordiyants, I.M., Kogan E.A., Barabasheva S.S. Sanogenesis versus pathogenesis. Status Praesens. Gynecology, obstetrics, barren marriage. 2018; 6(53): 79-83. (in Russian)].
  21. Радзинский В.Е., Ордиянц И.М., Коган Е.А. Пути преодоления привычного невынашивания. Саногенез эндометрия в профилактике рецидива выкидыша: возможности системной энзимотерапии. Информационный бюллетень. М.: Редакция журнала StatusPraesens; 2019. 20 с. [Radzinsky V.E., Ordiyants I.M., Kogan E.A. Ways to overcome habitual miscarriage. Sanogenesis of the endometrium in the prevention of recurrent miscarriage: the possibilities of systemic enzyme therapy. News bulletin. M.: Editorial staff of Status Praesens; 2019. 20 p. Russian)].
  22. Ордиянц И.М., Коган Е.А., Барабашева С.С., Молчанова О.К. Возможности системной энзимотерапии хронического эндометрита после неразвивающейся беременности. Акушерство и гинекология. 2020; 12: 186-93. https://dx.doi.org/10.18565/aig.2020.12.186-193. [Ordiyants I.M., Kogan E.A., Barabasheva S.S., Molchanova O.K. Possibilities for systemic enzyme therapy in patients with chronic endometritis after missed abortion. Obstetrics and Gynecology. 2020; 12: 186-93. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.12.186-193.
  23. Буданов П.В. Оптимизация лечения больных с воспалительными заболеваниями придатков матки. Эффективная фармакотерапия в акушерстве и гинекологии. 2007; 5: 14-9. [Budanov P.V. Optimization of the treatment of patients with inflammatory diseases of the uterine appendages. Effective pharmacotherapy in obstetrics and gynecology. 2007; 5: 14-9 (in Russian)].
  24. Тец Г.В., Артеменко Н.К., Заславский Н.В., Артеменко К.Л., Кнорринг Г.Ю.,Тец В.В. Влияние экзогенных протеолитических ферментов на бактерии. Антибиотики и химиотерапия. 2004; 49(12): 9-13. [Tets V.V.,Knorring G.Yu., Artemenko N.K. et al. Influence of exogenous proteolytic enzymes on bacteria. Antibiotics and chemotherapy. 2004; 49(12): 9-13.(in Russian)].
  25. Тец Г.В., Артеменко Н.К., Заславская Н.В. Влияние экзогенных протеолитических ферментов на передачу плазмидных генов в смешанных бактериальных биопленках. Антибиотики и химиотерапия. 2009; 9-10: 6-9. [Tets G.V., Artemenko N.K., Zaslavskaya N.V. Effect of exogenous proteolytic enzymes on plasmid gene transfer in mixed bacterial biofilms. Antibiotics and chemotherapy. 2009; 9-10: 6-9. (in Russian)].

Received 12.12.2022

Accepted 21.12.2022

About the Authors

Nelli I. Kokhno, PhD, Associate Professor, obstetrician-gynecologist of the highest qualification, Center of Reproduction and Genetics LLC, +7(495)461-08-52,
drkohno@gmail.com, 105043, Russia, Moscow, Parkaya 3rd str., 12.
Oksana V. Gorshkova, PhD, Associate Professor, Department of Obstetrics and Gynecology, Institute for Advanced Training of Healthcare Specialists,
Ministry of Health of Khabarovsk Region, +7(4212)72-87-15, goskana@mail.ru, 680009, Russia, Khabarovsk, Krasnodarskaya str., 9.
Larisa Yu. Molodtsova, PhD, obstetrician-gynecologist of the highest qualification, IRC LLC, +7(4212)46-69-32, larisamolodcova2@mail.ru,
680000, Russia, Khabarovsk, Gogolya str., 39.

Authors’ contributions: Kokhno N.I. – statistical analysis of the findings, writing the text of the manuscript; Gorshkova O.V. – collection of the data to be analyzed, development of the design of the investigation; Molodtsova L.Yu. – development of the design of the investigation, review of publications on the topic of the article, analysis of the findings, writing the text of the manuscript.
Conflicts of interest: The authors declare that there are no possible conflicts of interest.
Funding: The investigation has not been sponsored.
Patient Consent for Publication: The patients have signed an informed consent form to use impersonal data for the analysis and publication of results.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Kokhno N.I., Gorshkova O.V., Molodtsova L.Yu.
Efficiency of systemic enzyme therapy
in the combination treatment of pelvic inflammatory diseases in women.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 12: 159-164 (in Russian)

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