For effective treatment and preventive measures, anti-tuberculosis drugs are used - specific antibacterial agents intended for chemotherapy in patients with consumption.
Classification of funds
At various forms Oh pathological process They use drugs for pulmonary tuberculosis that have a high bacteriostatic effect against the causative agent of the disease.
Anti-tuberculosis drugs are divided into 3 groups: A, B, C. In many cases, first-line (main) substances are prescribed for therapy:
- Rifampicin;
- Pyrazinamide;
- Isoniazid;
- Ethambutol;
- Streptomycin.
If resistant forms of the tuberculosis pathogen appear and there is no effect of treatment, the patient is prescribed second-line (reserve) drugs:
- Ethionamide;
- Cycloserine;
- Amikacin;
- Capreomycin.
- Ofloxacin;
- Levofloxacin.
If the disease has gone too far, it is advisable to include bacteriostatic agents in the list of necessary means:
- Ethionamide;
- Terizidone.
Group 5 of drugs includes drugs with unproven activity:
- Amoxiclav;
- Clarithromycin;
- Linezolid.
It is necessary to follow certain rules when prescribing anti-tuberculosis drugs - the classification of drugs makes it easier to select the necessary drugs.
After diagnosis, taking into account the symptoms of the disease, the patient is registered at the dispensary. In the first accounting group, patients with an active form of tuberculosis are observed and treated.
There are several subgroups in which there are patients with destructive pulmonary tuberculosis that secrete bacteria in environment. Chronic course diseases of any localization are subject to careful monitoring and treatment, especially in the case of the development of cavernous and cirrhotic processes. After chemotherapy, residual changes in the lung tissue remain. Patients are under medical supervision.
A fairly common phenomenon is human contact with a source of tuberculosis infection. The patient must regularly visit the doctor to identify the primary infection. Children and adolescents with a tuberculin test are regularly examined by a TB specialist.
Treatment of lung disease is carried out in compliance with the basic principles:
- early use of effective chemotherapy;
- complex use of drugs;
- prescribing medications taking into account the characteristics of the pathogen;
- regular monitoring of the therapy process.
The patient is prescribed specific, pathogenetic and symptomatic treatment.
Vital medications
Tuberculosis tablets destroy sensitive mycobacteria, so they are used in the phase intensive care in order to stop the release of the pathogen into the environment. First-line drugs are prescribed to be taken for 2 months (at least 60 daily doses) for patients who are newly diagnosed with tuberculosis.
For treatment, 4 drugs are prescribed:
- Isoniazid;
- Rifampicin;
- Pyrazinamide;
- Ethambutol.
In an HIV-infected patient, Rifampicin is replaced with Rifabutin. To continue therapy for several months, the main drugs for the treatment of tuberculosis are prescribed - Isoniazid and Rifampicin. Often the patient is recommended to take 3 first-line drugs against tuberculosis - Isoniazid, Pyrazinamide and Ethambutol. The course of therapy lasts 5 months.
The tuberculosis treatment regimen is recommended for patients who have interrupted therapy or are undergoing a repeat course. If resistance of the tuberculosis pathogen is diagnosed, daily doses of drugs are prescribed in 1 dose to establish them high concentration in blood serum.
The anti-tuberculosis drug Pyrazinamide is prescribed to the patient if there are contraindications to the use of Ethambutol. The dose of the medication is determined taking into account the age and weight of the patient; Children and adolescents are prescribed the drug for medical reasons.
Combined products: advantages and disadvantages
Treatment of pulmonary tuberculosis in adults is carried out with the help of medications designed to control their intake and prevent overdose. Combined anti-tuberculosis drugs include 3-5 components.
The following medications are used in outpatient practice:
- Rifinag;
- Phthisoetam;
- Rimcourt;
- Prothiocomb.
Main components combined agents are isoniazid, ethambutol, vitamin B6. The medicine Lomecomb consists of 5 ingredients that influence the course of the acute process.
Combined drugs are prescribed to patients with tuberculosis diagnosed for the first time, as well as with severe resistance to isoniazid and rifampicin.
In the tuberculosis dispensary, therapy is carried out using the drugs Lomecomb and Protiocomb, which increase the effectiveness of treatment in the event of a progressive form of the disease. The main disadvantage of combined substances is the presence of side effects.
Reserve medicines
If it is not possible to achieve the effect of treatment with first-line drugs, the patient is prescribed backup drugs:
- Cycloserine;
- Ethionamide;
- Kanamycin;
- PASK.
Their use gives good results in the treatment of the disease.
For therapy-resistant dosage forms Levofloxacin from the group of fluoroquinolones is used. Daily dose set individually for each patient, taking into account the pharmacokinetics of the drug. If the patient does not tolerate Levofloxacin well, Avelox is prescribed, an antibiotic that has a universal effect.
Treatment of the intensive phase of pulmonary tuberculosis is carried out using combined drugs that cause the development of side effects. Levofloxacin is prescribed simultaneously with medications that eliminate its side effects on nervous system.
PASK provides bad influence on the stomach and intestines. The patient is recommended to take the medicine with water mixed with cranberry juice. Taking PAS is discontinued if the patient develops joint pain.
Side effect
The doctor monitors concomitant reactions during treatment with chemicals. The patient is prescribed blood and urine tests, ALT and AST in the blood are determined, the presence of creatinine is determined, and a doctor’s examination is recommended during treatment with aminoglycosides.
Side effects of anti-tuberculosis drugs appear unpleasant symptoms. Isoniazid causes headache, irritability, and insomnia. The patient is affected optic nerve, palpitations, heart pain, and symptoms of angina pectoris occur. Rifampicin (Ref) is difficult to tolerate by patients, because causes serious complications from the nervous system:
- visual impairment;
- unsteady gait;
- lack of correct orientation in space.
Often the patient develops an allergic reaction, accompanied by muscle pain, weakness, herpetic rashes, and fever.
Therapy with anti-tuberculosis drugs has a negative effect on digestive system. The patient complains of nausea, vomiting, pain in the stomach and liver. Kanamycin sulfate causes dyspeptic disorders, neuritis and the appearance of blood in the urine.
How to take medications
To treat pulmonary tuberculosis, a specific therapy regimen is prescribed. The medicine is taken in the dose recommended by the doctor, taking into account the stage of development of the disease.
The treatment regimen includes substances that enhance the effect of anti-tuberculosis drugs, for example, glutamyl-cysteinyl-glycine disodium. Patients with HIV infection receive therapy for 9-12 months.
Levofloxacin is prescribed if the causative agent of the disease is resistant to drugs of the main group. The antibiotic is taken continuously for 24 months. It has a bactericidal effect, but is not recommended for patients with kidney disease. The medicine is non-toxic, so patients tolerate it well.
For the treatment of adults, aminoglycosides are prescribed in combination with penicillins. Amikacin is administered intramuscularly, intravenously. The doctor prescribes the dose of the drug individually. During treatment, the patient is given plenty of fluids to drink. Amikacin should not be mixed with other drugs.
Patients with diabetes mellitus during treatment with Rifampicin and Isoniazid, blood glucose levels should be monitored.
PASK tablets are taken according to the instructions, washed down with milk or alkaline mineral water. Fraction ASD 2 is recommended for patients with severe tuberculosis.
Therapy with Dorogov's stimulant
If resistance to 1st and 2nd line drugs has developed, some patients use unconventional methods treatment. For pulmonary tuberculosis, the drug ASD has proven itself to be an antiseptic and stimulant that restores the cells of the diseased organ and the immune system.
Treatment with the ASD fraction improves lung function, increases the number of enzymes and restores the permeability of the cell membrane. As a result of the action of the drug, metabolism in the tissues of the diseased organ is activated. The medicine has bad smell, therefore, before taking it, it is mixed with juice or kefir.
Pulmonary tuberculosis in adults and children is treated according to a specific regimen. The dose of the drug is prescribed by the doctor. The duration of therapy does not exceed 3 months. In some cases, the patient develops an allergic reaction; in patients with unstable mental health, uncontrollable agitation occurs. In this case, the drug is discontinued.
The fraction is contraindicated for pregnant and nursing mothers. Modern pharmacology considers ASD as a natural complex, similar in structure to the substances that make up the human body.
New drugs
Among the best drugs note effective medicine SQ109, used to treat patients with pulmonary tuberculosis. After using it for 6 months, it is possible to stop the release of the pathogen into the environment. The medicine is safe and well tolerated by patients. SQ 109 is prescribed for combination therapy in combination with Isoniazid, Bedaquiline and Ampicillin.
New anti-tuberculosis drugs belong to the 2nd line drugs and have antibacterial effect. The patient is prescribed medications:
- Bedaquiline;
- Linezolid;
- Sparfloxacin;
- Ethionamide.
New anti-tuberculosis drugs help to successfully combat primary or secondary drug resistance Mycobacterium tuberculosis. Among the new drugs for tuberculosis effective action provide the drugs BPaMZ and BPaL, used for the treatment of tuberculosis various localizations. The drug BPaL is used to treat illness caused by resistant forms of the pathogen.
New drugs against tuberculosis are being tested clinical trials and significantly reduce the duration of therapy. The drug Prothiocomb reduces the number of tablets needed to take during the day several times, and its effectiveness is not inferior to the effect of single drugs.
Alcohol compatibility
Patients who abuse alcohol often develop tuberculosis. Treatment drinking man long-term, accompanied by severe complications. At alcohol addiction A patient with tuberculosis is prescribed drugs such as:
- Streptomycin;
- PASK;
- Rifampicin.
If during treatment the patient allows himself a small dose of alcohol, gastritis often develops after taking the medicine, increasing the load on the liver.
Amikacin in combination with alcohol causes nausea and vomiting. Symptoms of depression of the nervous system occur after the simultaneous use of the antibacterial drug Amikacin and strong alcoholic beverages. A bad habit and unauthorized cessation of treatment often lead to a decrease in the body’s defenses and the development of the cavernous form of tuberculosis.
Extremely dangerous combination the following medications with alcohol: Rifadina, Isoniazid, Ethionamide. After drinking small doses of alcohol, the patient develops symptoms of acute hepatitis. The simultaneous use of anti-tuberculosis drugs and alcohol disrupts the function of the pancreas and increases inflammation of the respiratory tract.
Contraindications for use
Anti-tuberculosis drugs do not always benefit the patient. Isoniazid is not prescribed to patients with liver disease, epilepsy and reactive psychosis. PAS causes exacerbation of stomach ulcers and duodenum, glomerulonephritis, nephrosis, hypothyroidism.
In the vast majority of cases, Amikacin is not recommended for patients suffering from pathologies of the organs of vision and hearing, or renal failure.
Sometimes patients complain of an allergic reaction during treatment with anti-tuberculosis drugs.
- Tavegil;
- Diazolin;
- Zaditen.
Ciprofloxacin is not prescribed to elderly people, pregnant women, hypersensitivity to the medicine. In tuberculosis dispensaries infusion therapy start with a jet injection of antibiotic.
- thrombophlebitis;
- hypertension of II and III degrees;
- diabetes mellitus;
- hemorrhagic diathesis;
- circulatory failure of II and III degrees.
During breastfeeding, taking Rifampicin and medications from the fluoroquinolone group is contraindicated.
Preventive action
A patient takes pills to prevent tuberculosis. Streptomycin is prescribed to pregnant women, patients suffering from pathologies of the brain, kidneys, and heart. Tuberculosis is prevented in children and adults using the drug Metazide. The drug has a bactericidal effect, but sometimes causes side effects:
- dizziness;
- nausea;
- vomiting;
- diarrhea;
- allergic reaction.
The medicine is taken simultaneously with vitamins B1 and B6. The drug is contraindicated in patients with diseases of the nervous system.
Prevention of tuberculosis in adults is carried out using an antibiotic wide range actions. Cycloserine is taken as prescribed by a doctor. The medicine is contraindicated for people with mental disorders abusing alcoholic beverages.
A drinking patient develops headache, tremor, disorientation, increased irritability. When taking an antibiotic, you must be careful because... the patient may experience seizures. In this case, the patient is prescribed sedatives and anticonvulsants.
The success of treatment of pulmonary tuberculosis depends on the exact implementation of the doctor’s recommendations and adherence to the treatment regimen.
Tuberculosis or consumption can creep up unnoticed and unexpectedly. Gone are the days when this infectious disease affected exclusively people leading an asocial lifestyle, eating poorly, and not taking care of their health. The danger of the disease is that the pathogen is present in the body of every person by the age of 30. Meanwhile, a mycobacterium that has once entered your body will wait for the moment to manifest itself. This situation can be caused by prolonged stress, poor nutrition, lack of physical activity for fresh air. Illness starting with mild cough and malaise, which you, of course, attribute to stress and a slight cold against the background of fatigue and reduced immunity, can develop rapidly. Remember, tuberculosis is curable, but treatment for tuberculosis takes a long time, up to one and a half years, if the diagnosis is made late. How successfully is tuberculosis treated, how is it treated in modern conditions new schemes and new principles are presented in this review.
Diagnosis of respiratory diseases becomes the lot of doctors multidisciplinary hospitals. Patients with tuberculosis must be treated by a phthisiatrician. If you, as a person who is conscious about your health, go to the clinic 1-2 times a year to receive consultations with doctors, then you will most likely be offered to go. Fluorography is also carried out as part of mandatory medical examinations and medical examinations.
Important! Based on the results of fluorography, when patients visit the general medical network at their place of residence, 30 to 50% of cases of tuberculosis are detected in the early stages.
Thus, early identified symptoms are the key to a speedy recovery and the key to a favorable prognosis.
During illness, mycobacterium (the original infection) enters the body, forming the primary focus of inflammation. Strong immunity will not allow the source of inflammation to grow, it will be isolated in the tissue by a dense capsule. A weakened body is an ideal environment for the spread of tuberculosis infection. When the body's defenses decrease, the primary focus of inflammation is activated, and the infection spreads through the blood into the body's tissues. It is with the spread of infection throughout the body that weight loss is associated.
How does infection develop in the body?
Having penetrated the body with a current of air through the airborne route of infection (this happens most often), Mycobacterium tuberculosis will remain in the body for a long time and wait for the right moment to manifest itself.
initial stage
Symptoms indicating that a person has the initial stage of tuberculosis:
- Body temperature rises slightly; a person cannot always independently assess his or her elevated temperature. Typically, when the infection spreads, the temperature is 37–37.5 degrees Celsius, and often rises in the evening.
- The patient most often experiences increased sweating at night.
- Sudden weight loss - up to 5-10 kilograms or more. The process of weight loss is associated with poisoning of the body and its need to get rid of mycobacteria.
- A person feels loss of appetite, weakness, fatigue, and decreased performance.
If you have three or more of the listed points, you must urgently contact the nearest medical facility and have fluorography done.
Spread of tuberculosis throughout the body
A pathogen that is not identified in time contributes to the spread of infection in the body. At this stage, the disease becomes more obvious, the symptoms of tuberculosis make themselves felt, forcing the person to consult a doctor - chest pain appears, rejection of mucus with blood from the lungs - hemoptysis. Lymph nodes enlarge.
The lung tissue is gradually destroyed, which causes the separation of blood from the lungs. As a result of the destruction of lung tissue, cavities are formed - cavities, which are filled connective tissue, not responsible for oxygen exchange in the lungs.
The focus can be located in the lungs and pleura, that is, the respiratory organs; symptoms of respiratory tuberculosis - respiratory diseases And respiratory failure. If the source is outside respiratory organs– then the symptoms will be intoxication and fever.
Chronic forms
Late detection of the disease often plays a role in the formation chronic form diseases. Besides, high value has correctly selected treatment, the social and living conditions of the patient, the presence bad habits, intolerance to certain medications. Even with timely and correct treatment, the factor of complete recovery largely depends on the body’s resistance abilities. How long tuberculosis is treated in each specific case will depend on the complex of methods used, but on average the duration is up to 6 months.
How to completely cure tuberculosis
Tuberculosis, detected in a timely manner, can be treated well with modern medicine. The arsenal of antibiotics used can cope with any form of tuberculosis. Depending on the form of the disease, the patient is treated either on an outpatient basis - this is possible if the discharge of Koch’s bacilli is external environment does not occur and the sputum test for BK is negative. In the open form, treatment is carried out in a hospital - a tuberculosis dispensary.
The disease can be cured with integrated approach to treatment. It is important to remember that only a TB doctor should diagnose pulmonary tuberculosis and prescribe treatment. The main methods of treating tuberculosis that are used in our country are medication and surgery. Pulmonary tuberculosis is treated at all stages of the disease.
Principles of treatment of pulmonary tuberculosis in adults and children
Treatment of tuberculosis in children, as well as in adults, is carried out in inpatient conditions in TB medical institutions. The most important component treatment of tuberculosis in children is careful monitoring during implementation and the appointment of a more gentle regimen. Tuberculosis in children and adolescents is cured on average within 2 months. Preferred in the treatment of pulmonary tuberculosis in children and adolescents are:
- Simultaneous use of no more than two drugs in minimal dosages;
- Carrying out procedures that strengthen the body - exercise therapy, massage, physiotherapy aimed at the chest;
- Strengthening the patient's immunity.
The recovery time for the body after an infection in children is generally shorter than in adults. At correct mode nutrition and the presence of strengthening factors for the body, the child’s body is completely restored in 4–12 months and the symptoms of the disease disappear. It is important during this period to form a special resistance of the body to mycobacteria that cause the disease.
Treatment in hospital
Important! To cure tuberculosis completely, you must follow the doctor's instructions. Strictly follow the treatment regimen, observe the dosage and frequency of medications, since antibiotics only work if taken regularly.
Most effective way Tuberculosis treatment remains in the hospital. Now there are modern methods treatment of this infectious disease. The main advantages of treating tuberculosis in a hospital include: isolation of the patient from possible sources of infection and worsening the situation, constant monitoring of the condition and adjustment, control over compliance with medications.
The treatment regimen for tuberculosis includes chemotherapy, surgical interventions, pathogenetic treatment and collapse therapy.
Chemotherapy
The only option for a complete cure for tuberculosis in a hospital setting is chemotherapy. Along with chemotherapy, medications are prescribed that increase the effect on mycobacterial components.
The treatment regimen consists of the first (bacteriostatic and bactericidal) and second (sterilizing) stages. The medicine for tuberculosis, used in the first stage, allows you to get rid of most mycobacteria. At the second stage, pathogens that are in a latent, dormant state are destroyed.
Medications
Important! To cure tuberculosis completely and not to lose, but to acquire the body’s defenses, it is required correct scheme treatment prescribed by a TB doctor. It should take into account the stage of tuberculosis, its localization, the duration of the process and the sensitivity of your specific pathogen to antibiotics.
Only the doctor decides how to treat tuberculosis, what treatment regimen to choose and how many days the treatment should last. As long as the mycobacterial component remains in the patient’s sputum, it is better for him to be in a hospital - an anti-tuberculosis dispensary, so as not to pose a threat of infection to others. Medicines for tuberculosis that most effectively cope with infectious pathogens are (R), (Z), (S) and (E).
After 20–25 days, the patient stops secreting infectious pathogens in his sputum - he is no longer infectious to others.
Tuberculosis is treated by a combination of chemotherapy and phthisiology methods, with the organization of proper nutrition and regimens healthy sleep and rest.
Chemotherapy regimens for tuberculosis include stages where drugs are needed to treat tuberculosis, which lasts 2–3 months. After this, a period of stabilization begins. During this period, the patient continues to take the medications rifampicin and isoniazid, up to 4–6 months. This measure helps prevent the return of symptoms of the disease and the development of complications.
Throughout the treatment, total monitoring of the patient’s health status is carried out with the help of and. Antibiotics for pulmonary tuberculosis may stop helping, despite the efforts of phthisiatricians, if the disease becomes resistant to medicines form. To prevent the development of drug-resistant forms of tuberculosis, the World Health Organization updated recommendations on the use of antibiotics in 2017 and introduced new concepts of ACCESS, SUPERVISION and RESERVE.
Pathogenetic therapy
To cure tuberculosis completely and not to lose, but to gain the body’s defenses, the correct treatment regimen is required, which is prescribed by a TB doctor. It should take into account the stage of tuberculosis, its localization, the duration of the process and the sensitivity of your specific pathogen to antibiotics.
To restore the resources of the body, weakened by prolonged exposure to antibiotics and tuberculosis infection, drugs of the pathogenetic spectrum are prescribed. During the treatment process, the tissue regeneration processes of the respiratory organs are affected. Excluding pathogenetic treatment and limiting chemotherapy methods can lead to an imperfect type of healing of the affected tissues.
Pathogenetic drugs
Pathogenetic drugs include those used in complex treatment tuberculosis include:
- Anti-inflammatory;
- Non-steroidal drugs;
- Steroid drugs;
- Other drugs for tuberculosis with anti-inflammatory activity.
Patients are treated with a combination of methods aimed at increasing immune defense body. This includes the prescription of a complex of immunomodulator drugs that affect T-lymphocytes.
Alternative Treatments
Next, we will try to answer the question of whether the so-called infection can be treated or not. People suffering infectious disease For many years, when it periodically makes itself felt, people wonder whether tuberculosis can be cured completely. Practice shows that the disease is curable with early diagnosis, chemotherapy and compliance with social and everyday recommendations.
There are several recommendations on how to treat pulmonary tuberculosis. Folk remedies cannot replace the appointments of a phthisiatrician, however, they remain a reliable help in matters of additional symptomatic treatment pulmonary tuberculosis and increased immunity.
It is necessary to follow a daily routine - walk in the fresh air, drink boiled or sterilized milk and grape juice. To expectorate phlegm, it is good to use an infusion of marshmallow root and a decoction of coltsfoot leaves. Pour a tablespoon of dry raw material into a glass of boiling water and hold in a water bath for 15 minutes, take a third of a glass 3 times a day before meals. Ledum infusion (a tablespoon of raw material is infused in a glass of boiling water for an hour, consume 2 tablespoons 3 times a day before meals), decoction pine buds(Pour 1 teaspoon of kidneys into a glass of boiling water and hold in a water bath for 15 minutes, leave for 1–1.5 hours).
For tuberculosis, fish oil is also prescribed 3 times a day before meals, a teaspoon. Eating white cabbage is beneficial.
A popular cure for tuberculosis, which can be used in addition to the main therapy, is the use of honey with milk and other high-calorie foods with the addition of aloe juice.
Prevention of recurrence of the disease
Doctors recommend that people who have been ill and recovered, as well as when the process is chronic, spend time in the fresh air, preferably breathing sea air. No wonder Anton Pavlovich Chekhov, suffering from consumption, moved from Taganrog to Yalta by the sea to improve his health. recommended as a preventive measure for relapse of the disease. For example, in Crimea there are unique natural conditions of increased oxygenation ( high content oxygen in the air), which prevent the spread of mycobacteria, and also give new strength to the body to fight infection. Don't forget what's right balanced diet also treats tuberculosis patients, as does fresh air.
Collapse
Tuberculosis is an insidious and serious disease. A person can be a carrier of Koch’s bacillus for a long time, but the pathology does not manifest itself in any way, and no dangerous symptoms are observed. But any negative factors can transform the disease into an active form, then without long-term treatment not enough. Therapy is usually carried out in specialized medical institutions. But sometimes outpatient treatment of tuberculosis is possible, what is it and in what situations is it allowed.
What it is?
If tuberculosis therapy is carried out in a hospital, the patient is under the supervision of doctors around the clock throughout the course. Outpatient treatment includes the following:
- The patient must come to the office every day outpatient department and take medications under medical supervision.
- Undergo routine examinations and tests at the department.
Home therapy has significant advantages over inpatient treatment. The risk of infection with chemo-resistant mycobacteria, which may be present in inpatient departments, is eliminated. In addition, being at home has a positive effect on a person’s psychological state.
Another important advantage, most likely for the state, is that this type of therapy significantly reduces the cost of anti-tuberculosis treatment and saves money for those patients who need hospitalization.
Indications and contraindications
Is it possible to treat tuberculosis on an outpatient basis? Yes, but only if he has his own testimony for this:
- The patient has tuberculosis in initial stage.
- The person is not dangerous to others.
- The health and life of the patient is not in danger.
- No high risk development of serious complications.
- The patient is in a mentally adequate state.
- Age and health status allow you to come to the outpatient department every day.
If a decision is made to conduct therapy on an outpatient basis, the TB specialist must constantly monitor the progress of treatment.
Contraindications to this type of therapy are:
- The disease is in the active phase.
- A person can infect others.
- It is not possible to visit the outpatient department every day.
- The patient has mental illness.
- The life and health of the patient is at risk due to the severity of the stage of the disease.
- Available chronic pathologies complicating the course of the disease.
Whether outpatient treatment is possible or not, only the doctor decides in each specific case.
Stages and treatment plan
Almost all anti-tuberculosis institutions have outpatient departments. The essence of their therapy is as follows:
When treating tuberculosis, regardless of the location, be it inpatient or outpatient, it is important to adhere to the following principles:
- Timely initiation of therapy.
- Maintaining a hygienic regime in terms of nutrition and daily routine.
- Carrying out etiotropic therapy aimed at taking antibiotics and chemotherapy drugs that can combat mycobacteria.
- An integrated approach that involves combining several drugs and treatment methods at the same time.
- Pathogenetic therapy. This principle involves the use of methods that will stimulate the immune response and increase the body's resistance to infection.
- Treatment is symptomatic. For example, taking medications for fever or sleeping pills for sleep disorders.
- Collapsotherapy methods. With their help in pleural cavity Gas is injected to cause the pathological area of tissue in the lungs to collapse.
During therapy, it is also important to maintain continuity; you cannot take breaks in taking medications, otherwise mycobacteria will develop resistance to the active ingredients of the medications.
Any therapy also involves following certain steps:
- Intensive therapy, which is most often recommended to take place in a hospital setting.
- At the second stage after removal acute symptoms treatment of the disease can be continued on an outpatient basis.
Treatment of tuberculosis in outpatient setting involves taking antibacterial agents that have a detrimental effect on Koch bacilli. Among these are: “Isoniazid”, “Ethambutol”, “Rifampicin”, “Streptomycin”. If there is increased resistance of mycobacteria to such drugs, then fluoroquinolones and pyrazinamide are used.
Before prescribing the medicine, it is necessary to carry out bacteriological examination on the sensitivity of mycobacteria to antibiotics.
Detection resistant strains forces doctors to prescribe several antibacterial agents to patients at the same time. In the treatment of tuberculosis, specialists resort to the use of three treatment regimens:
- At the same time, Isoniazid, Streptomycin and Aminosalicylic acid are being taken.
- When more resistant strains are discovered, a four-part scheme is used. To the first two components from the first regimen: “Rifampicin” and “Pyrazinamide”.
- The five-component regimen, in addition to the previous one, involves taking Ciprofloxacin.
The duration of therapy depends on the severity of the disease. Early-stage tuberculosis will require taking medications for 3-4 months, and if a five-component regimen is prescribed, then therapy will most likely last at least a year.
Except listed drugs immunomodulators, for example, interferon-based drugs, are added to the therapy regimen. Physiotherapeutic procedures provide significant assistance in therapy. Breathing exercises are recommended for all patients. The outpatient department has a physical therapy room, where a set of exercises is performed under the guidance of a specialist.
Don't also forget about proper nutrition during tuberculosis therapy. The diet should be rich in vitamins, minerals and all useful substances for the body.
Where is outpatient treatment in the Russian Federation?
Almost every TB dispensary has an outpatient department. If we talk about Moscow, then this medical care can be obtained from the following institutions:
- Anti-tuberculosis dispensary on the street. Dokunina, 18.
- Branch of the International Scientific and Practical Center for the fight against tuberculosis of the Department of Health in the South-Western Administrative District No. 4.
- Anti-tuberculosis clinical dispensary No. 21 on Metallurgov Street.
- Moscow regional dispensary on the square Struggles, 11 and others.
In our northern capital In St. Petersburg there are no problems with this either, go through effective treatment tuberculosis can be found at the following addresses:
- Anti-tuberculosis dispensary No. 2 on the street. Children's, 14.
- Anti-tuberculosis dispensary on the street. Serdobolskaya.
- Leningrad regional anti-tuberculosis dispensary at the address: lane. Nogina, 5.
While studying outpatient treatment It is important to remember that even after undergoing procedures and taking medications in the department, you should follow all medical recommendations at home. Pay attention to your work and rest schedule, take recommended multivitamins, exercise breathing exercises. If the disease is in the initial stages of development, then this type of treatment will help to recover and cope with the pathology.
Tuberculosis can be caused by two members of the family Mycobacteriaceae squad Actinomycetales: M. tuberculosis And M.bovis. In addition, it is sometimes mentioned M.africanum- a microorganism that occupies an intermediate position between M. tuberculosis And M.bovis and in rare cases being the cause of tuberculosis on the African continent. The above microorganisms are combined into a complex M. tuberculosis, which is actually a synonym M. tuberculosis, since the other two microorganisms are relatively rare.
The man is the only sourceM. tuberculosis. The main mode of transmission of infection is airborne. Rarely, infection can be caused by drinking milk that is contaminated M.bovis. Cases of contact infection among pathologists and laboratory personnel have also been described.
Typically, long-term contact with the bacteria-releasing agent is necessary for infection to develop.
Selecting a therapy regimen
Clinical forms of tuberculosis have little effect on the chemotherapy technique; the size of the bacterial population is more important. Based on this, all patients can be divided into four groups:
I. Patients with newly diagnosed pulmonary tuberculosis (new cases) with positive smear results, severe abacillary pulmonary tuberculosis and severe forms of extrapulmonary tuberculosis.
II. This category includes persons with a relapse of the disease and those in whom treatment did not produce the expected effect (positive sputum smear) or was interrupted. Once the initial phase of chemotherapy is completed and the sputum smear is negative, the continuation phase begins. However, if mycobacteria are detected in sputum, the initial phase should be extended for another 4 weeks.
III. Patients suffering from pulmonary tuberculosis with limited parenchymal involvement and having negative sputum smears, as well as patients with non-severe extrapulmonary tuberculosis.
A significant part of this category consists of children, in whom pulmonary tuberculosis almost always occurs against the background of negative sputum smears. The other part consists of patients infected during adolescence who developed primary tuberculosis.
IV. Patients with chronic tuberculosis. The effectiveness of chemotherapy for patients in this category is low even at present. It is necessary to use reserve drugs, the duration of treatment and the percentage of adverse events increases, it is required high voltage from the patient himself.
Treatment regimens
Standard codes are used to designate treatment regimens. The entire course of treatment is reflected in two phases. The number at the beginning of the code shows the duration of this phase in months. The number at the bottom after the letter is placed if the drug is prescribed less than 1 time per day and indicates the frequency of administration per week (for example, E 3). Alternative drugs are indicated by letters in brackets. For example, the initial phase of 2HRZS(E) means daily administration of isoniazid, rifampicin, pyrazinamide in combination with either streptomycin or ethambutol for 2 months. After completion of the initial phase at negative result sputum smear microscopy begins the continuation phase of chemotherapy. However, if after 2 months of treatment mycobacteria are detected in the smear, the initial phase of treatment should be extended by 2-4 weeks. In the continuation phase, for example 4HR or 4H 3 R 3, isoniazid and rifampicin are used daily or 3 times a week for 4 months.
Table 3. Example of four-component therapy for tuberculosis (in adults)
directly observed, including 62 doses of drugs
| First 2 weeks (daily) | |||
| Isoniazid | 0.3 g | ||
| Rifampicin | 0.6 g | ||
| Pyrazinamide | 1.5 g with body weight less than 50 kg |
2.0 g with body weight 51-74 kg |
2.5 g with body weight more than 75 kg |
| Streptomycin | 0.75 g with body weight less than 50 kg |
1.0 g with body weight 51-74 kg |
|
| 3-8 weeks (2 times a week) | |||
| Isoniazid | 15 mg/kg | ||
| Rifampicin | 0.6 g | ||
| Pyrazinamide | 3.0 g with body weight less than 50 kg |
3.5 g with body weight 51-74 kg |
4.0 g with body weight more than 75 kg |
| Streptomycin | 1.0 g with body weight less than 50 kg |
1.25 g with body weight 51-74 kg |
1.5 g with body weight more than 75 kg |
| 9-26 weeks (2 times a week) | |||
| Isoniazid | 15 mg/kg | ||
| Ethambutol | 0.6 g | ||
CHEMOTHERAPY REGIMS LESS THAN 6 MONTHS DURATION
Some researchers report good results from 4- and even 2-month courses of chemotherapy for mild forms of tuberculosis. However, most experts do not recommend stopping treatment earlier than after 6 months.
THERAPY OF MULTI-RESISTANT TUBERCULOSIS
In each specific case, it is advisable to determine the sensitivity of mycobacteria to anti-tuberculosis drugs. If resistance to first-line drugs is detected, use alternative drugs, such as fluoroquinolones (ofloxacin, ciprofloxacin), aminoglycosides (kanamycin, amikacin), capreomycin, ethionamide and cycloserine.
REPEATED COURSE OF THERAPY
The approach to a second course of therapy depends on the following circumstances:
- Relapse after sputum negativization usually indicates that previous treatment was stopped prematurely. In most cases, the sensitivity of the pathogen is preserved and observed positive effect when prescribing standard initial therapy.
- Relapse is due to resistance to isoniazid. In this case, a second course of chemotherapy with rifampicin is prescribed in combination with two other anti-tuberculosis drugs to which sensitivity is preserved, for a total duration of 2 years.
- Relapse after irregular use of anti-tuberculosis drugs is often caused by resistant mycobacteria. In this case, it is necessary to quickly determine sensitivity and prescribe drugs to which sensitivity is preserved.
- If resistance is suspected, the therapy regimen is changed using drugs to which sensitivity is presumably preserved.
- Multiple resistance to the most “powerful” drugs -
Tuberculosis is a dangerous and contagious disease that is extremely difficult to treat in running forms. The earlier the disease is detected, the more favorable the prognosis. At making the right choice anti-tuberculosis drug, active interaction between the patient and the doctor can be achieved full recovery in a few months. Otherwise, the process may drag on for years without yielding a positive result.
Types of 1st line drugs
The selection of a drug regimen for the treatment of tuberculosis begins after diagnosis accurate diagnosis and is based on many factors.
Healthy people who have been in contact with an open case will be offered preventive therapy, which you can refuse.
If the disease has been diagnosed for the first time, it begins to be treated with first-line substances, including synthetic antibacterial drugs and means natural origin. They:
- have most active against Koch's stick;
- have minimal toxic effects on the body;
- designed for long-term use.
According to doctors and patients, the most effective treatment options are:
- "Isoniazid".
- "Rifampicin".
- "Streptomycin".
- "Pyrazinamide".
- "Ethambutol."
They are usually prescribed as the main medications, and to increase effectiveness, 2-3 are used simultaneously. This reduces the likelihood of addiction.
The appearance of various side effects from anti-tuberculosis drugs is quite common.
Second line agents
If taking a medicine from the first group is impossible, resort to additional ones. They are classified as the second row. The substances are characterized by higher toxicity and less impact on the pathogen. Long-term use, which is simply necessary in the treatment of tuberculosis (an average of 10 months), can have an extremely negative effect on the health of the liver and the entire body as a whole. Such medications are prescribed in cases where it is really necessary.
With long-term use of a first-line anti-tuberculosis drug, mycobacteria become resistant to the substances, they no longer work at full strength, so the mentioned drugs are replaced with others.
Second-line medications include:
- PASK.
- "Prothionamide".
- "Ofloxacin"
- "Kanamycin".
- "Ethionamide."
- "Capreomycin".
- "Amikacin".
- "Cycloserine."
- "Ciprofloxacin"
Sometimes it is necessary to resort to second-line anti-tuberculosis drugs if the patient has been infected with mycobacteria that are already resistant to the main treatment, or has been observed allergic reactions on him.
Depending on the indications, these medications can be used in conjunction with basic medications or separately from them.
Reserve
When the use of both groups is impossible according to indications, patients are prescribed substances that have severe toxicity and have less effect on the mycobacterium than the popular isoniazid and rifampicin.
This group includes:
- "Clarithromycin."
- "Clofazimine."
- "Amoxicillin."
- "Ftivazid".
- "Thioacetazone."
- "Florimicin".
- "Flurenizide".
New drugs
Progress does not stand still. Scientists regularly conduct research to create new anti-tuberculosis drugs.
The list of recent achievements includes:
- "Perchlozone". Appeared in tuberculosis dispensaries since the beginning of 2013. Compared with other agents that suppress the activity of mycobacteria, it has minimal toxicity and high level efficiency. The exact mechanism of action is still unknown. Application in childhood, during pregnancy and lactation is included in the list of contraindications. Severe renal and liver failure - too. Its cost starts from 20,000 rubles. in Moscow pharmacies.
- "Sirturo." As active substance Bedaquiline is from the group of diarylquinolines. The drug is included in the list of new generation anti-tuberculosis drugs. It was created in 2014, and since then has proven itself well as part of complex therapy for the disease. Positive dynamics were observed after the third month of use. It is expensive, the price per package in different pharmacies ranges from 2000 to 4000 euros.
- "Mycobutin." A synthetic antibiotic that destroys any form of tuberculosis, including inactive and resistant ones. There is no information regarding the safety of use during pregnancy, lactation and in children, because the study of the substance is ongoing. Costs about 25,000 for a pack of 30 pieces. 1 tablet is prescribed per day.
There are few reviews about new medications; most patients do not risk purchasing them because they are in the development stage and are very expensive. Those who took the risk claim that the disease was defeated in 2-3 months, while standard first-line medications in most cases begin to act no earlier than after 6 months.
Additional medications and differences in classification
- "Repin V6".
- "Laslonvita".
- "Isocomb".
- "Rifter."
- "Protub-3".
- "Tubavit."
- "Rifinag".
- "Pthizoetam B6".
- "Protubetam."
- "Izo Eremfat."
The above classification is the most popular, however, in the International Union Against Tuberculosis, group 1 includes only drugs based on isoniazid and rifampicin.
To the second group they include:
- "Kanamycin".
- "Streptomycin".
- "Cycloserine."
- "Ethambutol."
- "Viomycin."
- "Prothionamide".
- "Pyrazinamide".
They are considered moderately effective.
And in the third group, substances have low effectiveness, these are:
- "Thioacetazone."
- PASK.
Based on these different classifications, we can conclude that the principles of treatment of tuberculosis differ significantly. In Russia, the first option is taken as a basis.
"Rifampicin"
This medicine has pronounced action against many gram-positive microorganisms. Active against most mycobacteria, including atypical ones.
When used as a single drug, it quickly becomes addictive and its therapeutic effect is reduced, therefore, for the treatment of tuberculosis, it is combined with other first- or second-line substances, and sometimes used in combination with reserve drugs.
Indications for the use of "Rifampicin" are all forms of tuberculosis, including damage to the brain by mycobacterium.
Not prescribed for:
- severe damage to the liver and kidneys;
- all types of hepatitis;
- various types of jaundice;
- pregnancy in the 1st trimester.
The following may be taken with caution:
- pregnant women in the 2nd and 3rd trimesters;
- small children;
- patients with alcoholism;
- HIV-infected patients receiving proteases.
The medicine can have many side effects, including the following:
- Gastrointestinal organs (nausea, vomiting, heartburn, constipation, diarrhea, colitis, damage to the pancreas).
- Endocrine system (dysmenorrhea).
- Central nervous system (headache, loss of balance, dizziness, impaired coordination of movements).
- Heart and blood vessels (decreased blood pressure, inflammation of the venous walls).
- Kidney (necrosis renal tubules, nephritis, organ dysfunction of varying severity).
- Circulatory system (thrombocytopenia, increased eosinophils, leukopenia, anemia).
- Liver (hepatitis, increased levels of bilirubin and transaminases).
Some patients experience individual intolerance, which may result in:
- skin rashes;
- Quincke's edema;
- respiratory dysfunction.
In this case, Rifampicin should be replaced.
During therapy, patients may notice that all biological fluids turn reddish. Doctors assure that there is nothing wrong with this. This is not blood, but only a side effect of the drug, which actively penetrates into saliva, urine, and sputum.
Concomitant use with:
- glucocorticoids - their effectiveness decreases;
- isoniazid - toxic effects on the liver increase;
- oral contraceptives - increases the possibility of developing unwanted pregnancy(which is unacceptable during tuberculosis treatment);
- indirect coagulants - there is a deterioration in the therapeutic effect of the latter;
- pyrazinamide - affects the concentration of rifampicin in serum.
Reviews about the medication are quite different. Some patients note pronounced effect And fast recovery, others report numerous side effects, mainly liver-related. Many noticed that during the reception they suffered greatly the immune system, there were problems with the growth of fungal flora.
Doctors consider a broad-spectrum antibiotic to be quite effective and claim that a deterioration in well-being can be observed both while taking rifampicin and additional substances. More often side effects observed in individuals who skip capsule doses.
Indications for the use of rifampicin include the possibility of its use as prophylactic.
"Isoniazid"
Belongs to the group of hydrazides. It has a bacteriostatic effect on all forms of tuberculosis in the active stage and a bactericidal effect on the bacillus at rest.
It can be prescribed as a prophylactic agent to children who have a Mantoux test of more than 5 mm in diameter, or to persons who have been in contact with a patient with an open form of the disease.
Therapy exclusively with Isoniazid causes rapid addiction, so its use as a monotherapy is not recommended.
IN official instructions on the use of "Isoniazid" it is indicated that its use is prohibited for:
- some central nervous system disorders, such as poliomyelitis, epilepsy, acute psychosis;
- acute renal and liver failure;
- availability cholesterol plaques on the walls of blood vessels.
For the treatment of patients in early childhood, pregnant and lactating women, the drug is used with caution. The substance can penetrate into everything biological fluids and cause developmental delays, neurological and other disorders.
When combined with Rifampicin, the toxicity of both substances increases.
At simultaneous administration with Streptomycin, excretion through the kidneys slows down, so if it is necessary to use such combinations, they must be taken at the maximum possible interval.
The dosage is selected individually in each specific case and depends on:
- forms of tuberculosis;
- presence of resistance;
- general condition of the patient;
- age, gender, weight and other things.
With long-term use, a number of side effects may occur:
- jaundice;
- nausea and vomiting;
- loss of appetite;
- feeling of euphoria;
- hyperglycemia;
- neurosis;
- psychosis;
- dysmenorrhea;
- gynecomastia;
- headache;
- convulsions;
- increased body temperature;
- fever;
- other.
The official instructions for the use of Isoniazid state that if complaints arise related to the start of therapy, a doctor’s consultation is required.
According to many doctors, patients who took Isoniazid in combination with other first-line drugs recovered 6-18 months after the start of treatment, but this is subject to early diagnosis. However, side effects were observed in only 15% of patients.
The patients themselves say that the treatment is quite difficult to tolerate, but it is difficult to assess the effect of a particular drug, since it is rarely prescribed as a monotherapy.
Most of those who used Isoniazid in for preventive purposes, did not notice a pronounced deterioration in health.
"Streptomycin"
Refers to 1st generation aminoglycosides. It is a fairly old broad-spectrum antibiotic. It has been used for many years to treat tuberculosis.
Unlike other products, it is of natural origin. It was obtained from the waste products of certain types of microscopic fungi.
The substance is used by injection due to poor absorption from the gastrointestinal tract. It is excreted unchanged from the body. It disrupts the synthesis of protein molecules of mycobacteria, suppresses their reproduction and destroys the infection.
The dosage is selected individually. The average is 15 mg per 1 kg of weight. Injections can be given 1-2 times a day. It is not suitable as the main drug; to successfully eliminate the infection, it is combined with other medications, for example Rifampicin or Isoniazid.
Despite the natural process of obtaining the medicine, when taking it, unwanted reactions may occur from various body systems. This could be a malfunction:
- auditory and vestibular apparatus;
- central and peripheral nervous system;
- digestive organs;
- genitourinary system.
Sometimes individual intolerance to "Streptomycin" is observed.
The medicine began to be actively used for the treatment of tuberculosis in 1946. In those days it was possible to cure great amount people, but then the bacteria began to become resistant, so this moment the use of Streptomycin alone does not give the desired effect.
For this reason, there are few reviews about the drug; some consider it effective, others useless. Doctors often include such injections as part of complex therapy for tuberculosis and often observe positive dynamics.
Sometimes the use of Streptomycin has to be abandoned if patients experience hearing impairment, which can lead to complete deafness.
"Pyrazinamide"
A synthetic antibacterial agent used to treat various forms of tuberculosis. Produces a bacteriostatic and bactericidal effect.
The drug "Pyrazinamide" is produced exclusively in tablet form, because the best effect is observed when interacting with acidic environment. Once in the body, they penetrate directly into the lesions, where they affect pathogens.
Most often, phthisiatricians prescribe it in cases where the patient has already developed resistance to Rifampicin and Isoniazid.
It is not used for:
- gout;
- hyperuricemia;
- epilepsy;
- increased nervous excitability;
- decreased thyroid function;
- severe violations liver and kidney function;
- pregnancy.
Like any other anti-tuberculosis drug, Pyrazinamide is poorly tolerated by patients. According to them, during treatment they noted the following disorders:
- Liver enlargement and tenderness, development various pathologies from the organ.
- Exacerbation of peptic ulcers.
- Loss or deterioration of appetite.
- Nausea and vomiting.
- Iron taste in mouth.
In addition, taking pills can cause disturbances in the functioning of the nervous and hematopoietic systems and provoke various allergic reactions - from skin to systemic.
The most pronounced anti-tuberculosis effect is observed when taken simultaneously with:
- "Rifampicin".
- "Isoniazid".
- Fluoroquinolones.
According to doctors, such combinations can quickly give positive dynamics, provided that all prescribed medications are taken regularly. Frequently skipping pills can cause more severe side effects and lack of results.
"Ethambutol"
A synthetic antibacterial agent that acts exclusively on the active form of the disease. It has a bacteriostatic effect, i.e. it suppresses the reproduction of the pathogen.
Not effective as a prophylactic agent for persons in contact with the patient or for patients with suspected inactive tuberculosis.
Included in most therapeutic regimens for eliminating Koch's bacillus, especially if addiction has developed to the main remedies.
The drug "Ethambutol" is not used for:
- presence of resistance;
- optic neuritis;
- retinopathy;
- other inflammatory eye diseases.
In pediatric practice, it can be used from 2 years of age.
Among the most common side effects, patients note:
- nausea and vomiting;
- abdominal pain;
- dizziness;
- sleep disorder;
- increased amount of sputum;
- increased cough;
- the appearance of a rash and other allergic reactions.
PASK. "Cycloserine"
They belong to the 2nd row of anti-tuberculosis drugs and have less pronounced activity against mycobacteria.
Their use is resorted to in case of addiction to first-line anti-tuberculosis drugs or as part of complex therapy. Compared to basic medications, their prices are significantly higher and are not suitable for long-term treatment for everyone.
Capsules "Cycloserine", PAS and other similar drugs are prescribed in cases where the use of other medications is impossible.
They are not prescribed for the treatment of pregnant women and small children, as they have been proven Negative influence on the formation of the fetus and the further development of the baby.
Severe renal and liver failure is also included in the list of contraindications.
Patients who have used PAS for a long time note the appearance of:
- goiter caused by decreased work thyroid gland;
- nausea, vomiting, heartburn;
- malfunctions of the liver and kidneys;
- jaundice;
- swelling;
- fever;
- other complaints.
When taking Cycloserine capsules, thyroid dysfunction is not observed, but other side effects may be present. Also, the anti-tuberculosis drug has a pronounced effect on the nervous system, causing:
- Insomnia.
- Nightmarish dreams.
- Aggression, irritability.
- Euphoria.
- Psychoses.
- Cramps.
Concomitant use with alcohol increases the side effects from the central nervous system.
"Isoniazid" and "Cycloserine" lead to drowsiness and lethargy. When combined with PAS, its activity increases.
Many years ago, the diagnosis of tuberculosis sounded like a death sentence. Today everything has changed. Scientists have created many effective medicines to treat infection. The interaction of anti-tuberculosis drugs makes it possible to obtain positive dynamics several months after the start of therapy. Despite their toxicity, they will help to completely get rid of the disease and give a person a second chance.
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