The development of tuberculosis is associated with the introduction of mycobacteria (Koch's rods) into the body. Most often, the infection affects the vital part of the respiratory system - one or both lungs. The disease is dangerous, leading to death in the absence of effective measures. Correctly and timely selected medicine for tuberculosis allows you to stop the further development of a deadly infection, and restore the patient's health.
Indications for the use of tablets from tuberculosis
It is required to treat pulmonary tuberculosis with the help of tableted medicines in case of the appearance of characteristic symptoms of the disease:
- Constantly elevated body temperature (often not falling, subfebrile).
- Incessant cough.
- Expectoration of sputum with blood impurities.
- Frequent headaches.
- Sudden, significant weight loss.
- Shortness of breath during activity and rest.
- Nocturnal hyperhidrosis (intense sweating).
Drugs used in the treatment of tuberculosis are potent, and often cause side effects. This feature requires the patient to be under the strict supervision of the medical staff..
Treatment of an open form of the disease is traditionally carried out in a hospital setting. Persons suffering from closed tuberculosis are treated on an outpatient basis (at home), but must also be constantly monitored by a doctor.
Classification of anti-tuberculosis drugs
Each anti-tuberculosis drug belongs to a specific group of medicines. The classification of such drugs is based on the following characteristics of tablets:
- clinical activity;
- chemical composition;
- tolerance by the human body.
Most often, therapy begins with the use of first-line drugs. Other medicines can supplement the main therapeutic course, or be prescribed in case of high bacterial resistance to the originally used medicines.
First line drugs
The drugs in this group include:
- Rifampicin.
- Isoniazid.
- Streptomycin.
Rifampicin
Rifampicin contains the active ingredient of the same name. The drug in tablets or capsules is prescribed once a day, half an hour before meals. The drug is contraindicated in patients with severe forms of cardiopulmonary insufficiency, jaundice, kidney damage. The question of the possibility of using the drug during pregnancy and lactation is decided on the basis of "vital" indications.
Isoniazid
The active ingredient in the tablets is isoniazid. The remedy is used for all forms of active tuberculosis, as well as for the purpose of its prevention in persons who have had close contact with patients. The drug is taken orally once a day or 2-3 times a week. The use of tablets can be carried out by pregnant and lactating patients, but is prohibited in the presence of atherosclerosis, epilepsy, liver or kidney pathologies.
Streptomycin
This antibiotic, which belongs to the group of aminoglycosides, exhibits a wide spectrum of antimicrobial activity. The streptomycin-based medication is in the form of a powder used in the preparation of a solution for intramuscular injection. The agent is also prescribed in the form of aerosols, injected into the patient's body by intrabronchial, intratracheal methods. The frequency of use of the drug is once a day, or twice or thrice during the week. Among the main contraindications are childbearing, uremia, azotemia, intolerance to aminoglycosides.
Often the therapy of an infectious disease is based on the parallel use of 2-3 drugs of the first choice.
Second line drugs
Second-line drugs become relevant in case of insufficient effectiveness of the main therapy. These medications are used in combination with first-choice medications, or alone.
Tuberculosis treatment is supplemented by:
- Ofloxacin;
- Ethionamide;
- Ciprofloxacin.
Ofloxacin
Ofloxacin is an antibiotic from the group of fluoroquinolones, an analogue of nalidixic acid. These tablets are taken twice a day. If intracavernous therapy is necessary, the agent is used as a solution for infusions.
A distinctive feature of Ofloxacin is its good compatibility with other anti-tuberculosis drugs.
Ethionamide
The medicine is in the form of dragee tablets. It is prescribed for patients with various forms and stages of tuberculosis. The medication is taken after meals, 2-4 times within 24 hours, in the dosage prescribed by the doctor.
This tool has a certain degree of toxicity, which is why it is not used to treat pregnant women, patients with pathologies of the gastrointestinal tract, renal and hepatic insufficiency.
Cifprofloxacin
The duration of ciprofloxacin therapy for pulmonary tuberculosis often takes about 4 months.
Reserve drugs
If it is impossible to use drugs included in the 2 previous groups, patients are prescribed antibacterial agents with the following names:
- Ftivazid.
- Clofazimine.
- Florimycin.
- Thioacetazone.
- Flurenizide.
- Amoxicillin.
Many of these drugs are quite toxic, and require constant monitoring of the patient's condition.
Combined funds
Such medicines are represented by multicomponent tablet preparations with fixed doses of individual substances. Of the combined drugs for tuberculosis, the following are prescribed:
- Tibinex, Rifinag, Rimactazid (these drugs contain isoniazid and rifampicin);
- Ftisoetam, Tubovit, Isocomb (contain isoniazid, ethambutanol, rifampicin, vitamin B 6);
- Protiocomb, Lomecomb (active ingredients - isoniazid, lomefloxacin, pyrazinamide, ethambutanol, vitamin B 6).
The advantages of using combined drugs are less likelihood of overdose, the possibility of using both in the hospital and in the outpatient treatment of tuberculosis.
Modern treatment
The most modern anti-tuberculosis drugs are:
- Perchlozone, which effectively suppresses the activity of mycobacteria, has minimal toxicity.
- Sirturo is a new generation remedy containing bedaquiline. This drug is mainly included in complex therapy.
- Mycobutin is an antibiotic that is effective in all forms of tuberculosis, including inactive and resistant ones.
Unlike standard pharmacological products, leading to a cure for the patient after six months of persistent therapy, new drugs often help to defeat a serious illness in 2-3 months.
Interactions of various drugs
Although the first choice drugs are often combined with each other, the simultaneous use of Isoniazid and Streptomycin can slow down their excretion in the urine. That is why it is recommended to observe considerable intervals between the use of these drugs.
Also, the listed medicines are not prescribed for simultaneous administration with Rifampicin. If this rule is not observed, the hepatotoxicity of anti-tuberculosis drugs is significantly increased. In addition, combinations of Rifampicin and indirect anticoagulants, glucocorticoids, oral contraceptives, antidiabetic agents are not recommended, because this medicine leads to a weakening of the therapeutic properties of these drugs.
Features of the use of drugs for tuberculosis
Treatment of tuberculosis of the lungs is based on the observance of certain principles. Important in effective infection control are:
- early use of effective antibacterial drugs;
- the appointment of drugs, taking into account the identified features of the pathogen;
- complex use of funds prescribed by a doctor;
- regular monitoring of therapy.
Tuberculosis tablets are used in the intensive care phase, and help stop the release of the pathogen into the environment. The drugs of the first choice are often combined with each other, due to which it is possible to avoid the addiction of pathogens to the active substance.
Dosages of tablets and capsules for tuberculosis are calculated individually for each patient and are determined by the intensity of the pathological process.
Storage conditions
Most anti-tuberculosis drugs should be stored in dry places, protected from light, at a temperature not exceeding +25 degrees. It is important to control the unavailability of medicines for young children.
Side effects
The appearance of side effects from the use of anti-tuberculosis drugs is associated with their ability to influence metabolic processes in the body, cause vitamin deficiency, and disturbances in redox processes. Therapy with antibacterial drugs can lead to a decrease in hearing acuity, the development of peripheral polyneuritis, allergies, dysbacteriosis, candidiasis, and dysfunction of the main organs and systems.
Against the background of antibiotic therapy, the Jarisch-Herxheimer reaction may develop, which is the body's response to the intensive destruction of mycobacteria. This condition is observed in the first days of therapy, accompanied by a significant increase in body temperature, chills, a sharp drop in blood pressure, nausea, and intoxication syndrome.
Tuberculosis is an infectious disease caused by mycobacteria (Koch's bacillus) with the most frequent localization of manifestations in the lungs. Treatment of pathology should be comprehensive, continuous, include several anti-tuberculosis drugs, taking into account the sensitivity of the pathogen.
Drug groups
Each tuberculosis medicine is part of a specific group of drugs. This distribution is based on chemical composition, clinical activity and patient tolerance:
- the first row ("Isoniazid", "Rifampicin") - the most effective;
- the second row ("Streptomycin", "Kanamycin") - average efficiency;
- the third row ("Thioacetazone", "PASK") - less effective.
Highly effective drugs are used most often, combining each of them with drugs from other groups. The rest of the pills for tuberculosis are called reserve. They are used in cases where the pathogen is resistant to the active substances of the first row.
"Isoniazid"
The drug "Isoniazid" is used in the treatment of adults and children. Its action is directed to the active forms of the pathogen. In relation to mycobacteria at rest, it is ineffective. The shell contains mycolic acid, the synthesis of which is suppressed by the drug.
"Isoniazid" - a cure for tuberculosis of all localizations and forms. The dosage is selected individually, depending on which agent the specialist recommends combining the drug with.
- "Isoniazid" + "Rifampicin" - the course of treatment takes place for 6 or 8 weeks. The drugs are taken once a day in the morning on an empty stomach.
- "Isoniazid" + "Thioacetazone".
- "Isoniazid" + "Rifampicin" + "Pyrazinamide" - in a similar combination, the remedy is called "Rifater". Apply for 2 months daily, enhancing the effectiveness of treatment with "Streptomycin" or "Ethambutol".
- "Isoniazid" + "Ethambutol" - a medicine for tuberculosis as maintenance therapy.
"Rifampicin"
Features of the drug "Rifampicin": instructions for use (the price of the product is about 200 rubles) indicates that the substance effectively fights mycobacteria in the affected area, reaching the maximum concentration there. The causative agents of tuberculosis tend to quickly get used to it, which is why the drug is limited. It is not used when breastfeeding, because it tends to pass into breast milk in large quantities.
The price of which is indicated on specialized pharmaceutical sites, has side effects, manifested by the following conditions:
- cephalgia (headache);
- reversible renal failure (the work of the kidneys is restored after the completion of the drug);
- allergic reactions;
- dyspeptic manifestations - vomiting, diarrhea, bloating;
- visual impairment;
- changes in laboratory parameters of peripheral blood.
Para-aminosalicylic acid
"PASK" - a medicine for tuberculosis based on Produced in the form of tablets, solution, granules. The daily dose is divided into 3 doses, taken with milk, mineral water, a weak soda solution. In some cases, the doctor prescribes a daily dose in one dose.
The drug in an independent form is not prescribed, only in combination with other anti-tuberculosis drugs. Affects only pathogens that are in an active state. The resistance of mycobacteria to the active substance practically does not develop.
"Pyrazinamide"
Tuberculosis pills related to second-line synthetic drugs. It is used in combined any localization. The use of "Pyrazinamide" during pregnancy and lactation is possible provided that mycobacteria are resistant to other more effective drugs.
Once a month, the level of transamiases and the presence of uric acid in the blood should be monitored during prolonged treatment with the drug. Contraindications for use are:
- individual hypersensitivity to the active substance;
- severe disorders of the kidney system;
- organic pathology of the liver.
Fluoroquinolones
A group of drugs is used as a means of having a bactericidal effect, affecting mycobacteria both at rest and during the period of activity.
"Ciprofloxacin" is recommended in combination with others. The maximum concentration in the body is reached within a few hours from the moment of administration. May cause dyspeptic disorders, cephalgia, anxiety, allergic manifestations, decreased visual acuity.
"Ofloxacin" is a medicine for tuberculosis that affects the location of DNA in the pathogen cell. Available in tablets and solution for infusion. The daily dose is taken in two doses at 12-hour intervals. This allows you to constantly maintain the required concentration of "Ofloxacin" in the body.
"Lomefloxacin" is an effective drug with almost 100% bioavailability. The tool "interferes" with the DNA chain of the pathogen, changing its location in the cell. Contraindicated during pregnancy, lactation, children under 18 years of age.
New drugs
Innovations in the field of phthisiology are associated with the development of highly effective anti-tuberculosis drugs, the sensitivity of pathogens to which would not decrease over a long period of time.
New drugs for tuberculosis:
- "Perchlozone" - the substance has low toxicity to the human body, however, high activity against mycobacteria. Contraindications include pregnancy, lactation, childhood, individual hypersensitivity, pathology of the kidneys and liver.
- Mycobutin is a derivative of the antibacterial agent rifabutin used to treat chronic forms of the disease in patients resistant to Rifampicin. It is used not only as a therapy, but also for the prevention of the disease.
- "Bedaquiline" ("Sirturo") is an innovative drug that suppresses the production of vital enzymes by Mycobacterium tuberculosis. It is effective after 3 months of treatment (for comparison: other drugs show results in 1.5-2 years), giving negative test results.
Side effects of therapy
The occurrence of side effects is due to the fact that the drugs used significantly affect the metabolic processes that occur in the patient's body, and also cause the development of hypo- or beriberi, disorders of redox processes.
The most common side effects:
- hearing loss;
- peripheral polyneuritis;
- violation of the functions of the main organs and systems;
- allergic reactions;
- dysbacteriosis;
- candidiasis;
- dyspepsia.
A specific manifestation is the Jarisch-Herxheimer reaction - the response of the patient's body to the massive destruction of mycobacteria in the first few days from the start of therapy.
Folk remedies for tuberculosis
With long-term treatment, patients are ready to try any means, so long as they speed up the healing process. There are a number of recipes that enhance the effectiveness of drug therapy.
Pour a tablespoon of birch buds with 2 cups of diluted alcohol or vodka. Infuse until the solution acquires a cognac color. Take a tablespoon 3 times a day throughout the course of treatment.
Rinse the reed leaves, dry and chop to make 3 tablespoons. Pour 2 cups of water, boil for 5-7 minutes. Insist and strain. Drink 1/2 cup of liquid before each meal.
Honey and walnut are folk remedies for tuberculosis, the effectiveness of which depends on the correct combination. The nuts are crushed and the fat is melted. All ingredients are mixed in equal proportions. The mixture is put in the mouth and held until it melts on its own.
Pine or spruce resin is poured with alcohol 2-2.5 cm higher and closed with a lid. After a few days, the solution will become homogeneous. Melted pork fat and linden honey are added to it in the same amount. Take a teaspoon three times a day for six months.
It must be remembered that the use of any means and preparations should take place under the supervision of a qualified specialist.
Almost all patients with newly diagnosed TB can be cured, the key is to do it right. Treatment should be continuous and must include several anti-TB drugs (as prescribed by a doctor).
Combined antimycobacterial drugs
Rifampicin + isoniazid (150 mg + 100 mg and 300 mg + 150 mg respectively) tablets. Both drugs are used in 6- and 8-week chemotherapy regimens. The entire dose is taken once in the morning on an empty stomach.
Synonyms: rimactacid, rifanag-150 and rifanag-300. Contraindicated in liver pathology, severe renal failure, individual intolerance to isoniazid and / or rifampicin.
The Yarish-Gereksheimer reaction is a deterioration in the general condition of the patient in the first days from the start of treatment. Occurs as a result of the massive disintegration of the MBT. If, with the complex appointment of anti-tuberculosis drugs, it was not possible to identify which of them causes side effects, then with mild and moderate adverse reactions, the drugs are consistently canceled, and with severe reactions, the specific treatment is canceled altogether.
To prevent adverse reactions, chemotherapy drugs with a similar mechanism of action, or that cause the same toxic effects, should not be administered simultaneously. It is impossible to prescribe isoniazid and metazid at the same time. The combination of streptomycin sulfate, kanamycin, florimycin sulfate is contraindicated, since they all have the same effect. Elderly patients are recommended to prescribe 75% of the daily dose of each anti-tuberculosis drug and take breaks in treatment for 1-2 days weekly.
For the prevention and elimination of hypovitaminosis in the treatment with isoniazid, thiamine chloride (0.01 g 3 times a day) or thiamine bromide (1 ml of a 6% solution intramuscularly), pyridoxine hydrochloride (0.025-0.1 g 2 3 times a day or 1 ml of 5% solution intramuscularly). Vitamins B1 and B6 are administered every other day. The appointment of streptomycin sulfate, kanamycin, florimycin sulfate, pyrazinamide is combined with the use of ascorbic acid. When treating with ethionamide, niacin (nicotinic acid - 0.05 g twice a day) or nicotinamide (0.1 g 3 times a day) should be prescribed.
Among antihistamines, diazolin (1-2 tablets 3 times a day) or suprastin (0.025 g 3 times a day), claritin, loratadine (1 tablet per day), tavegil (0.001 g orally 2 times a day) are more often prescribed.
To normalize redox processes, the appointment of ascorbic acid (0.2 g 3 times a day or intravenously 5 ml of a 5% solution together with a 40% glucose solution), cocarboxylase (50-100 mg) and adenosine triphosphoric acid (1 ml of a 1% solution ) within 15-20 days.
To compensate for the deficiency of sulfhydryl groups, their donors are prescribed: (0.5-1 g 3-4 times) or unithiol (5 ml of a 5% solution).
Elimination of adverse reactions caused by a violation of deamination is achieved by the use of glutamic acid (1 g 3-4 times a day). The appointment of glutamic acid is mandatory in cases of dysfunction of the central nervous system and liver, especially in the treatment of cycloserine, ethionamide and pyrazinamide. Prevention and elimination of adverse reactions contribute to an increase in the effectiveness of treatment.
Resistance of mycobacterium tuberculosis to antimycobacterial drugs
In the treatment of patients with tuberculosis, drug resistance of Mycobacterium tuberculosis to antimycobaterial drugs may occur. Resistance does not occur simultaneously in all populations of Mycobacterium tuberculosis. For example, during treatment with streptomycin, mycobacterium tuberculosis can be detected in sputum at the same time resistant and sensitive to streptomycin. Sensitive and resistant strains of mycobacterium tuberculosis, as well as resistance of varying degrees, were found in the walls of caverns, tuberculoma and fresh foci of lung preparations removed by surgery.
In the combined treatment of patients with drug resistance, monoresistance or multiple resistance may occur. If MBT resistance to isoniazid and rifampicin develops simultaneously, then it is called multiresistance. There are primary and secondary drug resistance of Mycobacterium tuberculosis. With primary drug resistance, the patient's Mycobacterium tuberculosis is not sensitive to antibacterial drugs with which he was not treated. Secondary (acquired) resistance is formed in Mycobacterium tuberculosis in the course of anti-tuberculosis therapy.
Primary drug resistance is observed in 10-15% of TB cases for the first time. Treatment with a single drug leads to the rapid development of drug resistance - resistant populations of Mycobacterium tuberculosis can occur after 30 days. Faster and more often resistance develops to streptomycin and isoniazid. The use of a combination of drugs significantly delays the emergence of drug resistance.
Forms of mycobacterium tuberculosis resistant to various drugs do not differ from each other in their morphological properties, but their viability and metabolic processes are different.
In the process of antibiotic therapy, drug-dependent strains of Mycobacterium tuberculosis can be formed, the growth of which is accelerated under the influence of treatment with anti-TB drugs. There may also be cross-drug resistance, for example between streptomycin and florimycin.
The emergence of drug resistance is explained in different ways. It is assumed that drug resistance is a natural phenomenon inherent in all bacteria, which occurs spontaneously in the process of their reproduction. Under the influence of anti-tuberculosis drugs, MBT genetic mutations occur. It is also believed that drug resistance is due to the survival of more viable MBT.
After streptomycin, para-aminosalicylic acid and isoniazid appeared in the 40-50s of the 20th century, numerous studies showed that the treatment of tuberculosis with one drug, although it gave a short decrease in clinical symptoms, eventually led to the selection of resistant MBT and relapse of the disease. . At the same time, the combination of two drugs reduced the number of patients who developed a relapse of the disease, and the appointment of three anti-tuberculosis drugs - streptomycin, PAS and isoniazid - made it possible to achieve almost 100% treatment efficiency. Further basic microbiological studies provided an explanation for such clinical consequences. Independent mutants resistant to one of the anti-tuberculosis drugs appear with an expected frequency in untreated MBT populations.
Drug resistance to isoniazid and streptomycin occurs in one bacterium in a million, while for rifampicin this probability is one bacterium in 100 million, and for one in 100 thousand. Considering that in a typical tuberculous cavity with a diameter of 2 cm there are usually about 100 million bacteria, there are mutants for all anti-tuberculosis drugs.
The general principle of antimycobacterial therapy is that treatment with multiple anti-tuberculosis drugs reduces the likelihood of developing resistant organisms. Therefore, it is customary to use isoniazid and rifampicin for the complex treatment of the "fresh" MBT population. On the other hand, if monotherapy is administered sequentially, bacteria become increasingly resistant.
More often, drug resistance to anti-tuberculosis drugs occurs due to violations of the chemotherapy regimen (the number of anti-tuberculosis drugs in the regimen, their doses and duration of use); availability of anti-tuberculosis drugs, the process of taking drugs by patients with tuberculosis.
Common medical errors that lead to the selection of resistant strains:
Non-compliance by phthisiatricians with recommendations on prescribing evidence-based regimens of anti-tuberculosis therapy in the treatment of patients with newly diagnosed pulmonary tuberculosis; the use of less than 4 drugs in the intensive phase of treatment is a gross mistake;
The use of low daily doses of anti-tuberculosis drugs;
Frequent and long breaks in treatment for various reasons (indiscipline of patients, poor tolerance of anti-tuberculosis drugs, lack of adequate amounts of anti-tuberculosis drugs);
Failure to control the intake of anti-tuberculosis drugs. Secondary drug resistance of MBT is more often with an indicator of inadequate treatment of tuberculosis.
Primary drug resistance is a consequence of improper treatment of patients in the past, due to which secondary resistance has developed, and resistant MBT cause the development of tuberculosis in healthy individuals. Prevention of drug resistance consists in preventing the selection of resistant strains by prescribing adequate antimycobacterial therapy in accordance with the current requirements for the treatment of patients with tuberculosis.
The main principle of modern antimycobacterial therapy of tuberculosis, which ensures the prevention of drug resistance, is the use of at least 4 anti-TB drugs in patients with newly diagnosed tuberculosis in the intensive phase of treatment, and in case of relapse - at least 5 drugs.
Microbiological diagnosis of sensitivity of Mycobacterium tuberculosis to antimycobacterial drugs
Today, there are 3 ways to determine the drug sensitivity of MBT on the Levenshtein-Jensen medium: the method of absolute concentrations (minimum inhibitory concentrations), the determination of the resistance ratio and the method of proportions. Methods of absolute concentrations and determination of the resistance ratio require accurate standardization of the MBT culture, so their results are less reproducible. The proportion method, which uses a single standard of bacterial turbidity, namely 1 MCP, with three control dilutions, is becoming increasingly popular in clinical microbiology laboratories as an objective among culture laboratories.
Sensitive to antibacterial drugs are those MBT in which the drug at a concentration reached in the focus of infection has a bactericidal or bacteriostatic effect. MBT sensitivity to antibacterial drugs correlates with the minimum concentration of the drug delays (inhibits) the growth of MBT in a nutrient medium. MBT are considered resistant if growth of more than 20 colonies is determined in a nutrient medium containing an anti-tuberculosis drug.
Basic principles of treatment of patients with multidrug-resistant tuberculosis:
Use of second-line drugs (do not keep them in reserve);
Prescribing drugs that the patient has not previously received;
The treatment regimen at the initial stage should include at least 5 drugs.
Surgical treatment of multidrug-resistant tuberculosis is indicated in the absence of a therapeutic effect within 6-8 months. in the treatment of reserve drugs. After surgery, chemotherapy is continued for at least 18 months.
Ways and methods of administration of antimycobacterial drugs
The main methods of antibiotic therapy are as follows: conventional, single daily dose of the drug, intermittent. The usual method is the daily administration of individual anti-tuberculosis drugs 2-3 times a day. A one-time (basic in phthisiology) intake of a daily dose of anti-tuberculosis drugs provides a bacteriostatic concentration in the patient's blood that is sufficient for a therapeutic effect. This method allows to implement the principle of controllability of treatment, especially in outpatient practice. Adverse reactions with a single dose: the daily dose of drugs occur more often.
The intermittent method consists in prescribing a single daily dose of antimycobacterial drugs 2-3 times a week. Given the slow growth and reproduction of Mycobacterium tuberculosis, this method is recommended for continuing treatment of patients on an outpatient basis and for preventive courses of antibiotic therapy.
Methods of administration of anti-tuberculosis drugs:
- enteral - oral administration of drugs in tablets or capsules;
- parenteral - intramuscularly, intravenously;
- intrapleural;
- endolumbar - the introduction of drugs into the spinal canal;
- intratracheal - in the form of inhalation aerosols;
- rectal - in enemas, suppositories;
- endolymphatic - the introduction of drugs into the lymphatic vessels or nodes;
- in a fistula;
- into the joint;
- into the periosteum.
Infusion therapy does not cause dysfunction of vital organs. Solutions of isoniazid, rifampicin, PAS, ethambutol, ethionamide, can be administered intravenously.
Intravenous administration of solutions of anti-tuberculosis drugs should be carried out in separate wards or manipulation rooms that meet increased sanitary and hygienic requirements and strict observance of asepsis.
Intravenous administration of antibacterial drugs should be preceded by mandatory treatment of the patient according to the usual method for a week in order to determine the tolerability of the drugs. For the first time, no more than 50 ml of the solution should be administered, on the second day - 100 ml, on the third - 200 ml, and on the fourth day, with good tolerance, a daily dose (300-500 ml) of the solution can be infused. The infusion begins with 20 drops of the solution for 1 minute. After 1-2 min. the speed is increased to 30-40 drops per 1 min.
If chills, fever, or other unusual complaints occur, it is recommended to close the drip infusion system until the patient's condition is clarified. In the case of subjective signs of poor infusion tolerance, a slower infusion rate is used. After the end of the infusion, it is desirable to stay in bed for 2-3 hours. The temperature of anti-tuberculosis drug solutions should be at room temperature (20-22 °C) during infusion, since higher or lower temperatures are more likely to cause post-infusion reactions.
There are three ways to administer anti-tuberculosis drugs: jet, drip (a daily dose of drugs is administered over 1-2 hours), round-the-clock drip. The second method is most often used.
Contraindications to the infusion of anti-tuberculosis drugs:
According to statistics, tuberculosis is one of the ten leading causes of death worldwide.. Thanks to the WHO End TB Strategy, the incidence rate is gradually decreasing globally (by about two percent per year). And yet, tuberculosis continues to be the most complex and significant social and medical problem.
The death rate from tuberculosis is about 1.7 million people a year.
Before the discovery of antibiotics, tuberculosis was considered an absolutely incurable disease. At the moment, many highly effective treatment regimens for this disease have been developed, however, multidrug-resistant forms of tuberculosis present significant difficulties for treatment.
Due to the rapid growth of the resistance of Mycobacterium tuberculosis to antibacterial drugs, all treatment should be prescribed exclusively by a phthisiatrician, after a complete examination and obtaining cultures for the sensitivity of the pathogen to drugs. It is strictly forbidden to independently adjust the treatment, dosages, regimens and frequency of administration, as well as stop treatment ahead of time.
Treatment of tuberculosis at home with folk remedies is unacceptable. Herbs, infusions, a method popular on the Internet - dried Medvedka from pulmonary tuberculosis are not effective and cannot replace a full-fledged complex anti-tuberculosis therapy.
It must be understood that folk remedies for pulmonary tuberculosis in adults and children can only be used as an addition to the treatment prescribed by a phthisiatrician for a general strengthening purpose. All folk recipes and herbs for tuberculosis can be used after consultation with a phthisiatrician.
Tuberculosis is a curable disease, but a number of factors must be taken into account. Mycobacterium tuberculosis are widespread bacteria and are characterized by a high level of survivability and the ability to adapt to various environmental factors. In some cases, Koch's wand can go from active to dormant, while becoming immune to the effects of antibiotics.
Also, the bacterium is able to quickly develop resistance to the drugs used.
In particular, a high risk of developing multidrug-resistant tuberculosis (unresponsive to most or all known anti-TB drugs) is observed in patients with HIV and in those who miss timely intake of prescribed drugs, stop treatment prematurely, etc.
It must be understood that for a complete cure for tuberculosis, a long period of time and regular medication are needed. Early withdrawal of therapy (with stabilization of the patient's well-being) can cause reactivation of the infection and the development of resistance to the drugs used.
At the same time, if a patient has open tuberculosis, he can infect others with a multidrug-resistant disease (first of all, relatives of the patient are at risk).
The medicine for tuberculosis is selected by a phthisiatrician in a hospital. As a rule, complex treatment is prescribed, including four to five agents. The duration of treatment and the selected schemes are strictly individual.
How many live with tuberculosis in an open form
With timely admission to the hospital, good sensitivity of mycobacteria and the absence of concomitant pathologies that aggravate the severity of the patient's condition, the disease is curable.
Treatment of tuberculosis in a hospital
The open form of tuberculosis is highly contagious. In this regard, all treatment takes place in the conditions of an anti-tuberculosis dispensary. The duration of the transfer of an open form to a closed form is individual and can range from two to four or more months.
The duration of further treatment is also individual.
Patients with closed forms of tuberculosis can be treated at home. In the future, patients are prescribed supportive, as well as sanatorium-and-spa treatment.
Disability in pulmonary tuberculosis
In most cases, the issue of registration of disability for tuberculosis is considered if the treatment takes more than ten months. The decision to assign a group is made on the basis of the results of a medical and social examination. The disability group assigned to the patient depends on the severity of the disease and the degree of impairment of body functions.
The main indications for referral to the ITU (medical and social examination) are:
- duration of treatment more than 10-12 months;
- the appearance of completely or partially irreversible violations of body functions, leading to the fact that the patient needs a change in working conditions;
- severe course of the disease, accompanied by disability and / or the need for outside help (loss of ability to self-service);
- the need to conduct another re-examination, change the previously established cause of disability, change the previously assigned group, receive recommendations regarding further employment.
According to the results of the medical commission, the patient is assigned the status of temporary disability or a disability group corresponding to the severity of his condition. Assignment of social and labor pensions to patients with tuberculosis is carried out in accordance with the received disability group.
As benefits, patients are entitled to:
- registration of a sick leave for a period of nine to twelve months, with guaranteed job retention;
- registration of social insurance benefits;
- provision of free medicines from a special list of anti-tuberculosis drugs;
- free spa treatment.
Where can I work after tuberculosis
Admission to work after tuberculosis is issued by the VKK (Medical Advisory Commission). Permission to continue studies or return to work is issued on the condition that:
- complete completion of the course of anti-tuberculosis treatment;
- lack of symptoms of the disease;
- laboratory-confirmed absence of bacterial excretion (triple analysis and intervals of two to three months);
- no signs of reactivation of pathological processes.
Patients after tuberculosis are strictly forbidden to work in the following areas:
- healthcare (hospitals, pharmacies, laboratories, etc.);
- Catering;
- education and in preschool children's institutions (kindergartens, schools, institutes, etc.);
- trade.
Also, patients after tuberculosis are contraindicated in hard physical work, work involving contact with dust, chemicals, coal dust, hot air (work in workshops), night shifts, etc.
Patients after tuberculosis are allowed to work as accountants, statisticians, programmers, economists, work at home or in workshops at a tuberculosis dispensary, repair shops, etc.
Treatment of pulmonary tuberculosis in adults
To achieve maximum effectiveness, therapy should be timely, combined, strictly controlled and regular (skipping medication is unacceptable), long-term and sufficiently intensive, phased, and also prescribed taking into account the sensitivity of mycobacteria to the antibacterial drugs used.
Anti-tuberculosis drugs (TBDs) are usually divided into three groups:
- class A medicines (the most effective drugs) - drugs of isoniazid (tuberculosis tablets isoniazid are among the most effective and commonly prescribed drugs) and rifampicin;
- class B drugs (medium effective drugs) - drugs of streptomycin, ethambutol, pyrazinamide, ethionamide, kanamycin, cycloserine, viomycin;
- class C drugs (low-potency drugs).
The main drugs used in classical regimens include isoniazid (H), rifampicin (R), ethambutol (E), streptomycin (S), pyrazinamide (Z).
Second-line reserve drugs include thioacetozone (T), prothionamide (Pt), ethionamide (Et), kanamycin (K), amikacin (A), capreomycin (Cap), cycloserine (Cs), rifabutin (Rb), PASK (PAS), fluoroquinolones (Fq), amikacin (Am), etc.
The classic scheme for tuberculosis is the appointment of isoniazid, rifampicin, pyrazinamide, ethambutamol and streptomycin (H, R, Z, E, S). In this case, streptomycin is used for a course of no more than two months. Combinations of RHZE or RHZ may also be given. For maintenance courses, a combination of rifampicin and isoniazid is prescribed.
For convenience, combined means are often used:
- Rifater (isoniazid, rifampicin and pyrazinamide);
- rifampicin, isoniazid and ethambutamol and others.
Treatment of tuberculosis in children
Treatment of tuberculosis in children is carried out according to similar schemes (usually HRZE). Dosages are calculated depending on the weight of the patient.
In addition to tuberculosis chemotherapy, for the treatment of children and adults, collapse therapy (creation of artificial pneumothorax and pneumoperitoneum), thoracoplasty, therapeutic fibrobronchoscopy, physiotherapy exercises, breathing exercises can be used (for tuberculosis, breathing exercises according to Bolotov, etc. can be used).
Surgery for pulmonary tuberculosis
Surgery is used as an adjunct to chemotherapy. For the treatment of tuberculosis can be used:
- thoracoplasty (removal of ribs);
pneumolysis (creation of an artificial cavity with a gas bubble, but is rarely used today); - surgical interventions on the peripheral nerves, in order to change the blood circulation and lymph circulation in the lungs;
- resection of the affected lungs;
- decortication and pleurectomy;
- cavernotomy;
- surgery to stop pulmonary bleeding.
Treatment of tuberculosis after surgery is continued according to previously prescribed chemotherapy regimens.
Treatment of tuberculosis with folk remedies - the most effective schemes
Patients often ask the phthisiatrician whether it is possible to put mustard plasters for tuberculosis, use herbs and can they replace drug treatment? No. All treatment should be complex, long-term and individual. Tuberculosis cannot be cured without antibiotics.
Despite the fact that long-term antibiotic therapy is fraught with various complications, in this case, this is a justified risk. Early discontinuation of drugs can lead to the development of a completely drug-resistant form of the disease.
No folk remedies can cure tuberculosis. The use of honey with aloe, fish, badger, bear fats, herbal tinctures, etc. are not pathogenetic therapy for tuberculosis. All these funds can only be considered as a general strengthening addition to the antibiotic treatment regimen prescribed by the doctor.
Consequences of tuberculosis
The consequences of the disease are divided into complications of tuberculosis during the active phase of the disease and the consequences of long-term treatment with anti-tuberculosis drugs, as well as surgery (thoracoplasty for tuberculosis is used in severe cases of the disease, as an addition to chemotherapy).
Complications of pulmonary tuberculosis can be:
- development of cardiopulmonary insufficiency;
- the appearance of hemoptysis or pulmonary bleeding;
- development of spontaneous pneumothorax;
- the formation of tuberculous pleurisy, pleural empyema, atelectasis, etc.;
- attachment of extrapulmonary forms of tuberculosis (tuberculous meningitis, lesions of mesenteric lymph nodes, etc.)
- disability as a result of residual changes in the lungs (fibrous, fibrous-focal, bullous-dystrophic, cirrhotic, pleuropneumosclerotic, etc.), as well as due to impaired respiratory function after surgical treatment (removal of part of the lung, etc.);
- development of secondary tuberculosis, etc.
It should also be noted that since pathogenetic therapy for tuberculosis can
take more than a year (the duration of treatment depends on the severity of the disease and the sensitivity of Mycobacterium tuberculosis to antibiotics), patients often experience various side effects from long-term and intensive antimicrobial therapy:
- allergic reactions;
- violations of the functions of the liver and kidneys;
- jaundice;
- disorders of the gastrointestinal tract;
- heart rhythm disturbances;
- accession of fungal infections;
- problems with conceiving and bearing a child;
- pain in muscles and joints;
- headaches, dizziness;
- noise in ears;
- severe dysbacteriosis;
- weakness;
- sustained rise in temperature;
- anxiety, insomnia, depressive disorders;
- changes in the hemogram (leukocytopenia, neutropenia, thrombocytopenia);
- blood clotting disorder, etc.
To reduce the risk of side effects, all antibiotics for tuberculosis should be taken under the control of laboratory parameters of liver function, kidney function, blood clotting, etc.
Tuberculosis and HIV infection
HIV infection and tuberculosis have a mutually reinforcing effect on each other. It should be noted that it was the HIV epidemic at the end of the last century that became the main reason for the rapid increase in the incidence of tuberculosis throughout the world.
HIV remains the leading risk factor for developing tuberculosis in adults and children. According to statistics, tuberculosis is the most common infection leading to the death of patients with HIV.
In this case, there are two options for combining these infections:
- accession of tuberculosis in patients with HIV or acquired immunodeficiency syndrome (AIDS);
- accession of HIV or AIDS in patients with active tuberculosis or exacerbation of the process after the end of treatment.
The high incidence of tuberculosis in patients with HIV allows us to conclude that when the immune system is affected by the human immunodeficiency virus, a latent post-tuberculosis infection, previously present in the patient, but restrained by its own immunity, is reactivated.
Due to damage to the immune system of HIV, as well as impaired differentiation of macrophage cells and the formation of specific granulation tissues, in patients with tuberculosis in the late stages of HIV, specific tuberculous granulomas may not form.
The severity of tuberculosis directly depends on the stage of HIV. The less CD4 cells in the patient's blood, the faster and more severe the damage to the lungs.
A feature of the development of tuberculosis in patients with AIDS can be considered its malignant and fulminant development, the rapid progression of lung decay in tuberculosis, the tendency to severe necrotic reactions, as well as the frequent addition of extrapulmonary forms of tuberculosis (tuberculous meningitis, lesions of mesenteric lymph nodes, etc.) and the ineffectiveness or ineffectiveness of prescribed anti-tuberculosis treatment.
How many live with HIV and tuberculosis together?
With the addition of tuberculosis sensitive to antibiotic therapy in the early stages of HIV, subject to adequate antiretroviral and anti-tuberculosis treatment, patients can live 10, 20 or more years (terms are individual).
For multidrug-resistant forms of tuberculosis or the addition of tuberculosis already in the late stages of AIDS (tuberculosis in the decay stage in such patients is characterized by a fulminant malignant course), as well as if the prescribed drug regimens are not followed, the prognosis is unfavorable (less than a year).
Article prepared
infectious disease doctor Chernenko A.L.
The first thing you need to know about tuberculosis is that when meeting with a sick person, Koch's wand can not affect everyone, but only those who have reduced immunity. Therefore, for the prevention of tuberculosis, it is important to lead a healthy lifestyle, strengthen your immunity, eat regularly and diversified, and take long walks. After all, there is little chance of never meeting carriers of tuberculosis. All of them, like healthy citizens, use public transport, walk in parks, go shopping...
In the event that you do not smoke, and you have a cough of unknown origin with sputum secretions, it is best to undergo an examination at the nearest clinic. In general, it is necessary to do a fluorogram annually.
In the event that the results of the examination reveal that you have tuberculosis, the doctor will prescribe you adequate treatment. But you must understand that the treatment of tuberculosis depends mainly on the desire of the patient himself to be cured, and not only on drugs. Now let's look at what medicines are needed to treat tuberculosis.
The medical drug isoniazid.
Isoniazid comes in tablets. As a rule, treatment with this drug in accordance with the instructions gives good results.
True, sometimes in the first week of taking the drug, sleep disturbance, nausea, and skin rashes appear. The prevention of these complications can be the appointment of vitamin B.
Isoniazid tablets are stored in a place inaccessible to light, hermetically screwing the lid of the package.
The medical drug rifampicin.
Rifampicin is available in tablets and capsules. It is also well tolerated by most patients at recommended doses. As side effects there are intestinal disorders, headache, vomiting (rarely), nausea.
Red staining of saliva, tears, sputum and urine is observed. Permanently stained contact lenses. Take the drug 30-40 minutes before meals.
Rifampicin reduces the effect of birth control pills. Store tablets and capsules of the drug in a dark place in a hermetically sealed package.
The medical drug pyrazinamide.
Pyrazinamide is also available in tablets. Well tolerated. As side effects are known - nausea, dizziness, deterioration of appetite and mood, slight pain in the joints, burning sensation of the skin, sometimes - blurred vision.
The medical drug ethambutol.
The drug ethambutol is available in the form of tablets. Before taking it, check your eyesight. And if it worsens, stop taking the pills, tell your doctor right away. Tablets are stored in a hermetically sealed vial.
The medical drug thioacetazone paired with isoniazid.
These drugs are combined to prevent the development of Koch's bacillus resistance to drugs and to facilitate the treatment of tuberculosis.
However, treatment is stopped when a rash and vomiting appear, at high body temperature (up to 38 ° C). With these symptoms, you should immediately consult a doctor. It is also recommended to inform the doctor about the disorder of the stool and nausea.
Also, before taking any pills, ask your doctor what you need to know about the drugs prescribed by him and the timing of their use. Typically, the duration of treatment for tuberculosis is 6-12 months, followed by a fixing course for 1.5 years. In some cases, hospitalization is necessary so that the patient is constantly in front of the medical staff.
The closed form of tuberculosis can be treated under the supervision of a doctor and at home.
At the same time, you need to strictly follow the schedule for taking the drugs, because this is one of the prerequisites for the successful treatment of the disease. In addition to drugs, you can use