Few people know which pills for tuberculosis are the most effective. Tuberculosis is an infectious disease, where Koch's bacillus acts as the causative agent, which is transmitted by airborne droplets upon contact with the patient. Most often, the disease affects the lungs, but there are cases of tuberculosis of the joints, genitourinary system, bones and other organs of the body. Symptoms are not immediately recognized, which exacerbates the problem with treatment until the late stage of the disease. The active form can not appear for a long time due to strong immunity, which can contain the disease for a long time without visible signs.
Since the disease is difficult to trace in its initial form immediately after infection from a carrier of tuberculosis, the disease may not manifest itself for a long time. The following changes in the human body can serve as a warning factor:
- For no reason, uncontrollable weight loss.
- Elevated temperature.
- Frequent cough, blood fragments in the sputum.
- Unreasonable fatigue.
- Increased sweating, especially during sleep.
- Headaches, drowsiness.
Once in the body, the infection is not always able to activate its destructive actions. The reason for this is a strong immune system, which neutralizes the pathogen, neutralizing it.
There are risk factors that contribute to the transition of the disease to a progressive phase:
- nervous breakdowns, stressful situations, prolonged depression.
- Insufficient amount of protein food for the body.
- Systematic malnutrition, starvation.
- The presence of bad habits: the systematic intake of alcohol, smoking.
- Diseases that decrease immune system person.
Previously transferred diseases in severe form can seriously disrupt the human immune system, it is this factor that is decisive whether the body can fully resist the disease, or whether the infection will enter the active phase of development.
X-ray examination is the most effective way to detect tuberculosis at an early stage of the disease. The picture shows the areas affected by the disease as a darkening on the patient's lungs. Another way to detect infection is to test for the Mantoux reaction, for three days the test allows you to make an assumption about the presence of the disease.
Polymerase chain reaction is one of the modern methods of diagnosing a disease at an early stage. The studied sputum analysis using DNA diagnostics allows you to determine the presence of the disease with high accuracy.
An infectious disease that has become chronic is more likely to affect men in middle and old age. Mycobacteria are mainly active in lung tissue damage. If the cure for tuberculosis is not detected and applied in time, the disease can fatally destroy human health.
Drugs for the treatment of the disease are divided into 3 categories. Group 1 includes drugs that provide a high effect of treatment and prevention of the disease. The most popular are pills for tuberculosis:
- Rifampicin.
- Isoniazid.
- Tubazid.
Group 2 provides a moderate effect:
- Florimycin sulfate.
- streptomycin sulfate.
- Cycloserin and others.
Group 3. The drugs are aimed at curing the disease with a moderate action.
- PASK.
- Thioacetazone.
Domestic phthisiology uses a different classification method for the treatment of the disease, which provides for a drug against tuberculosis, divided in two directions. When treating the disease with the first group, the following drugs are used:
- Streptomycin.
- Isoniazid.
The reserve group, the second, includes the following drugs against tuberculosis:
- Cycloserine.
- Kanamycin.
- Ethionamide and others.
Treatment of pulmonary tuberculosis with the help of the listed drugs in compliance with the basic measures is carried out strictly in medical institutions under the supervision of specialists.
The drugs listed above are drugs for pulmonary tuberculosis. The tablets contain antibiotics and synthetic agents. Below are the main drugs that, as already found in practice, most effectively cure the disease and, at the right doses, are normally tolerated by patients.
Rifampicin. The agent belongs to the antimicrobial ansamycins, which provide a wide range of applications, including tuberculosis. It has a destructive effect on manifestations in bacteria, providing a connection with RNA polymerase, a cell that cuts off reunification with DNA and suppresses transcription. The task of Rifampicin is to block the formation of poxviruses at the last stage of formation. The drug is well absorbed by the gastrointestinal tract, and then recirculated.
Long-term use of it reduces the bioavailability of the drug. During the use of the medication, it is not recommended to use foods with a high percentage of fats in food, as they complicate and slow down the resorption process. The drug is taken after the doctor prescribes a daily dose on an empty stomach, washed down with a glass of water, with poor tolerance, the dosage is divided into two parts. Rifampicin is taken in two regimens: either 3 times a week or every day. It is forbidden to give the medicine to children under the age of 1 year, and to patients who systematically consume alcohol.
Isoniazid is a drug based on isonicotinic acids used in the medical industry. Increased bacteriological activity, which is characteristic of isoniazid, helps to resist mycobacteria. The drug does not show a chemotherapeutic effect on pathogens of other infectious diseases.
Through the gastrointestinal tract, isoniazid enters the body by absorption and acts throughout the day. The highest concentration of the drug in the blood is observed in the first 4 hours after taking the required dose. The concentration that ensures the termination of the action of tuberculosis bacteria is maintained for a day after administration. The tool provides a break in the barrier of the blood-brain border, which is located between the brain tissue and blood.
The withdrawal of the drug occurs mainly through the kidneys during urination. The drug has proven itself in the treatment of newly identified foci of diseases that manifest themselves in an acute form. The drug is prescribed according to a combined scheme together with anti-tuberculosis drugs: fluoroquinolones, sulfonamides, broad-spectrum antibiotics. The drug has a different form of release: it can be administered intramuscularly, by inhalation, intravenously, by taking tablets and capsules.
Pyrazinamide. The main task of the drug is to penetrate and act in a destructive way on Mycobacterium tuberculosis. It freely penetrates into the foci affected by the disease. An acidic environment improves the effect of treatment.
Resistance is possible, which decreases when combined with other drugs used in the treatment of tuberculosis. The release of the drug is established only in the form of tablets, the substance contains 250 and 500 mg of the drug.
Treatment of such serious infectious diseases, like tuberculosis, is self-excluded. Only the constant supervision of specialists, repeated examinations, testing and general control can guarantee a complete cure for the disease. All drugs belong to the properties of chemotherapeutic substances that need to be taken for a long time without interruption.
like any medical preparations, pills for tuberculosis have their own characteristics and limitations in taking in the treatment of pulmonary tuberculosis.
- Pyrazinamide. The drug is available only in the form of tablets, taken during breakfast with a small amount of liquid. At times, partial intolerance to the drug is observed, in which case the dosage should be divided by 2 or 3 times. During the reception, patients may experience an unpleasant metallic taste in the mouth, indigestion, nausea. Ethambutol, Rifampicin are compatible with the drug for long-term use of chronic forms of the disease. The likelihood of developing hepatotoxic effects increases during combination with Rifampicin, while Ethambutol mitigates side effects, but the effect of treatment weakens.
- Isoniazid. A different form of release makes it possible to widely use the drug for the treatment of chronic tuberculosis. To avoid side effects, Pyridoxine is used, which is administered intramuscularly at the same time or later, 30 minutes after ingestion. The course of treatment with the drug is prescribed by a doctor, the required period for recovery ranges from 1 month to six months.
- Rifampicin. The drug is taken by the patient before meals and washed down with liquid. It is administered both orally and intravenously with a dropper. In case of poor tolerance, the drug is divided into parts to receive the daily dose. In the treatment of pulmonary tuberculosis, the drug is used in stages, divided into three regimens, combined with other drugs.
Side effects
The above drugs help to cure a serious infectious disease, but you should not be silent about their side effects. Only direct control medical workers able to prevent unwanted effects of drugs on the human body during their administration and in the future.
- Rifampicin. It is forbidden to take with infectious hepatitis, jaundice, severe pulmonary heart failure, CRF, during lactation, in infancy, transferred less than one year ago.
- Isoniazid. It is forbidden to prescribe to patients who have previously had polio, with impaired liver and kidney function, with atherosclerosis, a tendency to convulsive seizures, epilepsy. Extremely carefully it is necessary to prescribe a reception during pregnancy, pulmonary heart disease. Seizures may become more frequent in patients with epilepsy. With inflammation of the veins, the drug is strictly prohibited. In rare cases, during the reception in men, gynecomastia may be observed, in women, menorrhagia. During treatment, patients may experience mild euphoria, deterioration of the sleep period, and sometimes psychosis develops.
- Pyrazinamide. Gastrointestinal disorders reported: diarrhea, bad feeling, nausea, vomiting. During the reception, an unpleasant metallic taste is felt in the mouth. The drug disrupts the function of the liver, appetite worsens, hepatic ulcers become aggravated. Undesirable side effects from the side of the central nervous system are observed in the form of dizziness, headaches, nervousness, depression. Allergic manifestations on the skin of the hands are possible: redness, rash.
Only a doctor has the right to prescribe drugs for the treatment of tuberculosis after thorough comprehensive examinations of the patient in medical institutions, any self-medication can lead not only to undesirable results, but also to a fatal outcome.
87. Anti-tuberculosis drugs.
Anti-tuberculosis drugs- chemotherapeutic agents that inhibit the growth of acid-resistant mycobacteria, reduce virulence, prevent and reduce the incidence of tuberculosis.
basic anti-tuberculosis drugs
Isoniazid, rifampicin (rifampin), ethambutol, pyrazinamide, streptomycin
reserve anti-tuberculosis drugs.
Ethionamide, prothionamide, cycloserine, capreomycin, kanamycin, florimycin, rifabutin, amikacin, lomefloxacin, thioacetazone, PAS
other drugs (except for the main and reserve ones) that can be used in the treatment of tuberculosis.
Azithromycin, clarithromycin, dapsone, clofazimine, tetracyclines
the most active anti-tuberculosis drugs.
Isoniazid, rifampicin (rifampin), rifater (rifampicin + isoniazid + pyrazinamide), rifakom (isoniazid + pyridoxine)
anti-tuberculosis agents of medium activity
Streptomycin, kanamycin, pyrazinamide, prothionamide, ethionamide, ethambutol, cycloserine, florimycin, semozide, methoside, ftivazid, capreomycin.
anti-tuberculosis drugs of moderate activity.
PASK, thioacetazone, solutizone, pasomycin
bacteriostatic anti-tuberculosis drugs.
a) bactericidal and bacteriostatic : isoniazid, rifampicin
b) only bacteriostatic: pyrazinamide, ethambutol, prothionamide, PAS, thioacetazone.
anti-tuberculosis drugs acting on mycobacteria localized intracellularly.
Isoniazid, rifampicin, streptomycin, cycloserine
The spectrum of action of anti-tuberculosis drugs.
Synthetic anti-tuberculosis drugs - narrow spectrum of action (mycobacterium tuberculosis only, sometimes mycobacterium leprosy)
Antibiotics used to treat tuberculosis - broad spectrum (many MBs)
Name the spectrum of action of synthetic anti-tuberculosis drugs.
Effective only against Mycobacterium tuberculosis, some compounds are effective against Mycobacterium leprosy. Other MBs are practically unaffected.
spectrum of action of anti-tuberculosis antibiotics.
Broad spectrum of antimicrobial activity.
Mechanism of action of isoniazid.
Inhibition of enzymes necessary for the synthesis of mycolic acids in the cell wall of mycobacteria.
Mechanism of action of ethambutol.
1. Inhibits enzymes involved in the synthesis of the cell wall of mycobacteria, has a bacteriostatic effect.
2. Inhibits the synthesis of RNA of mycobacteria.
The mechanism of action of pyrazinamide.
The mechanism of action is not exactly known, but the most important condition for its antimicrobial activity is the conversion to pyrazinocarboxylic acid. It acts mainly bacteriostatically, has sterilizing properties.
Features of tuberculosis chemoprophylaxis in infected and uninfected individuals.
In uninfected persons, primary prophylaxis is carried out with BCG vaccine; in infected persons, secondary prophylaxis is carried out with one drug ( isoniazid) in a short course, if there are no clinical and radiological manifestations of tuberculosis.
What is the difference between primary and secondary chemotherapy of tuberculosis.
Primary chemotherapy- chemotherapy for newly diagnosed patients with tuberculosis.
Secondary chemotherapy- chemotherapy of patients previously treated with anti-tuberculosis drugs.
Principles of treatment of tuberculosis.
1) treatment should start as soon as possible when there are still no morphological changes in the organs
2) regularity of reception
3) prolonged(course up to 18 months) continuous(strict adherence to the drug regimen) treatment
4) stages of treatment(main course - 2 stages: 1) intensive treatment to transfer an open form to a closed one, eliminate decay cavities; 2) consolidation of the achieved results, prevention of relapses)
5) continuity of treatment at various stages: as a rule, the sequence of treatment is as follows: hospital (or day hospital) sanatorium outpatient treatment dispensary observation with anti-relapse courses
6) drug combination(up to 6 according to WHO, the use of isoniazid is mandatory; doses of drugs are usually not reduced; drugs with the same side effects cannot be combined)
7) individual approach to the patient
Duration of a standard course of tuberculosis treatment.
6-18 months (average 1 year)
DOTS (Directly Observed Tuberculosis Treatment Short Course) is a multipurpose, comprehensive tuberculosis control strategy proposed by WHO and the International Union Against Tuberculosis and Lung Disease.
DOTS provides:
government political and financial support for the TB program;
detection of tuberculosis by sputum examination in all patients who presented with symptoms suggestive of tuberculosis;
standard course of treatment within 6-8 months with direct control over medication;
regular and uninterrupted provision of all essential anti-tuberculosis drugs;
registration and reporting to evaluate the results of treatment for each patient and the TB program as a whole
DOTS allows:
reduce the "storage" of infection, the risk of contracting and getting sick with tuberculosis
stop the increase in the number of chronic patients with resistant forms of tuberculosis, reducing the increase in mortality and morbidity
combined preparations for the treatment of tuberculosis.
Rifater (rifampicin + isoniazid + pyrazinamide), rifakom (isoniazid + pyridoxine)
Side effects of isoniazid.
a) hepatotoxicity: temporary asymptomatic increase in transaminase activity, rarely hepatitis
b) neurotoxicity: irritability, insomnia, tremor, difficulty urinating, rarely - encephalopathy, memory impairment, psychosis, depression, fear, peripheral polyneuropathy, optic nerve damage c) hypersensitivity reactions: fever, flu-like syndrome, rash, eosinophilia, arthropathy, pancreatitis
d) hematotoxicity: sideroblastic anemia, sometimes thrombocytopenia, agranulocytosis
e) endocrine disorders: gynecomastia, dysmenorrhea, cushingoid
Side effects of ethambutol.
a) optic neuritis, peripheral neuropathies
b) hypersensitivity reactions - dermatitis, arthralgia, fever
c) a metallic taste in the mouth
d) dyspeptic disorders
Side effects of pyrazinamide.
a) dyspepsia: nausea and vomiting
b) hepatotoxicity: increased activity of transaminases
c) nephrotoxicity: interstitial nephritis
d) hyperuricemia, accompanied by arthralgia and myalgia (the main metabolite - pyrazinoic acid - inhibits renal excretion of uric acid)
e) hematotoxicity - thrombocytopenia, sideroblastic anemia.
Side effects of rifampicin.
a) dyspeptic and dyspeptic phenomena
b) staining of urine, saliva and lacrimal fluid in orange-red color
c) hepatotoxicity (up to the development of hepatitis)
d) hematotoxicity: thrombocytopenia, hemolytic anemia
e) flu-like syndrome (fever, arthralgia, myalgia)
Prevention of side effects of anti-tuberculosis drugs
the introduction of vitamins B1, B6, B12, C
fractional prescription of the drug or its cancellation for a short time
the use of bismuth preparations to reduce irritation of the gastrointestinal mucosa
the introduction of glutamic acid, antihistamines, calcium preparations to prevent allergic reactions
avoid the use of drugs that are incompatible with anti-tuberculosis drugs
monitoring of the functional state of body systems, which are affected by the drugs used
Isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin, ethionamide.
isoniazid (Isoniazidum).
Isonicotinic acid hydrazide.
Synonyms: GINK, Tubazid, Andrazide, Chemiazide, Cotinazine, Dinacrin, Ditubin, Eutizon, Hidranizil, INH, Isocotin, Isonicazid, Isonicid, Isonizid, Isotebezid, Neoteben, Niadrin, Nicazid, Nicotibina, Nicozid, Nydrazid, Pelazid, Pycazide, Pyrizidin, Rimicid, Rimifon, Tebexin, Tibizid, Zonazide, etc.
It is the main representative of isonicotinic acid derivatives, which have found application as anti-tuberculosis drugs. Other drugs in this group (ftivazid, etc.) can be considered as derivatives of isonicotinic acid hydrazide.
Isoniazid has a high bacteriological activity against Mycobacterium tuberculosis. It does not have a pronounced chemotherapeutic effect on other common pathogens of infectious diseases.
The drug is well absorbed from the gastrointestinal tract. The maximum concentration of the drug in the blood is found 1 to 4 hours after ingestion; within 6 to 24 hours after taking a single dose, tuberculostatic concentration in the blood remains. The drug easily penetrates the blood-brain barrier and is found in various tissues and body fluids. It is excreted mainly by the kidneys.
Isoniazid is used to treat all forms and localizations of active tuberculosis in adults and children; it is most effective in fresh, acute processes.
Assign in combination with other anti-tuberculosis drugs. With a mixed infection, it is necessary to take other antibacterial drugs (broad-spectrum antibiotics), sulfonamides, fluoroquinolines (see Ofloxacin) and others simultaneously with isoniazid.
Apply isoniazid inside, intracavernous, intramuscular, intravenous, inhalation.
When prescribing isoniazid and other drugs - derivatives of isonicotinic acid hydrazide (GINK), it should be borne in mind that these drugs are inactivated in the body at different rates. The degree of inactivation is determined by the content of active GINK in the blood and urine. The faster the drug is inactivated in the blood, the more it is required to provide tuberculostatic concentration in the blood, so patients in whose body rapid inactivation occurs are given the drug in slightly larger doses. To<быстрым инактиваторам>include patients who excrete up to 10% of active isoniazid in the urine per day in relation to the accepted dose, and to<<медленным (слабым)>> - emitting less than 10%.
The daily dose is set individually depending on the nature and form of the disease, the degree of inactivation and tolerability. The treatment is long.
Preventive course 2 months.
Intramuscularly (and intravenously) isoniazid is administered with active forms of tuberculosis, if the patient has difficulty ingesting (diseases of the gastrointestinal tract, intolerance).
To reduce side effects, pyridoxine is prescribed, which is taken orally simultaneously with the injection of isoniazid or administered intramuscularly 30 minutes after the injection.
Isoniazid is administered intravenously to adults and adolescents with common forms of pulmonary tuberculosis, with massive bacterial excretion and when it is impossible to ingest.
To prevent and reduce side effects, pyridoxine is used, as well as glutamic acid. Pyridoxine is administered intramuscularly 30 minutes after isoniazid injection or given orally every 2 hours after injection. Glutamic acid is taken at 1.0 - 1.5 g per day.
With intravenous administration of isoniazid, the patient should, after the injection, observe bed rest for 1–1.5 hours.
A 10% solution is injected intracavernously at a daily dose of 10–15 mg/kg, mainly for adults with cavernous and fibrous-cavernous pulmonary tuberculosis during bacterial excretion and preparation for surgery.
Inhalation use a 10% solution of 5-10 mg / kg per day (in 1-2 doses). The course of treatment - within 1 - 6 months daily.
When using isoniazid and other drugs of this series (ftivazid, metazid, etc.), headache, dizziness, nausea, vomiting, pain in the heart, skin allergic reactions. There may be euphoria, worsening sleep, in rare cases, the development of psychosis, as well as the appearance of peripheral neuritis with the occurrence of muscle atrophy and paralysis of the limbs. Rarely, drug-induced hepatitis has been observed. Gynecomastia is very rare in men and menorrhagia in women during treatment with isoniazid. Seizures may become more frequent in patients with epilepsy.
Usually, side effects disappear with a decrease in dose or a temporary break in taking the drug.
To reduce side effects, in addition to pyridoxine and glutamic acid, thiamine solutions are recommended - intramuscularly 1 ml of a 5% solution of thiamine chloride or 1 ml of a 6% solution of thiamine bromide (for paresthesia), sodium ATP salt.
Contraindications: epilepsy and a tendency to convulsive seizures, previously transferred poliomyelitis, impaired liver and kidney function, severe atherosclerosis.
Do not take isoniazid at a dose of more than 10 mg / kg during pregnancy, pulmonary heart failure stage III, hypertension stage II-III, coronary artery disease, widespread atherosclerosis, diseases nervous system, bronchial asthma, psoriasis, eczema in the acute phase, myxedema.
Intravenous administration of isoniazid is contraindicated in phlebitis.
Solutions prepared from powder can be stored at a temperature not exceeding + 10 C for no more than 48 hours.
Isoniazid in the form of a special dosage form (solution<<Изонинидез>> - Solution<
The drug is a solution containing 1 liter of isoniazid (10 g), low molecular weight polyvinylpyrrolidone, sodium chloride, potassium chloride, calcium chloride, sodium bicarbonate and water. Clear liquid (colorless or yellow). Foams when shaken.
The action is due to the ability of isoniazid to block the activity of enzymes involved in the biosynthesis of collagen (propyl hydroxylase, lysyl oxidase).
Applied once, in the abdominal cavity after surgery and careful hemostasis before suturing the wound.
In some cases, allergic reactions are possible.
RIFAMPICIN (Rifampicinum). 3(4-Methyl-1-piperazinyl-iminomethyl)-rifamycin SV 2 .
Semi-synthetic antibiotic, a derivative of rifamycin (see).
Synonyms: Benemycin, Rifadin, Rifamor, Benemycin, Rifadin, Rifaldazin, Rifaldin, Rifamor, Rifampin, Rifoldin, Riforal, Rimactan, Ripamisin, Tubocin, etc.
Rifampicin is a broad spectrum antibiotic. It is active against Mycobacterium tuberculosis and leprosy, acts on gram-positive (especially staphylococci) and gram-negative (meningococci, gonococci) cocci, less active against gram-negative bacteria.
Unlike rifamycin, rifampicin is more effective when taken orally and also has a broader antibacterial spectrum of action.
Rifampicin is well absorbed from the gastrointestinal tract. The maximum concentration in the blood is reached after 2 - 2.5 hours after ingestion.
With intravenous drip administration, the maximum concentration of rifampicin is observed by the end of the infusion. At the therapeutic level, the concentration of the drug when taken orally and intravenously is maintained for 8–12 hours, for highly sensitive pathogens - for 24 hours. Rifampicin penetrates well into tissues and body fluids and is found at therapeutic concentrations in pleural exudate, sputum, and cavity contents. , bone tissue. The highest concentration of the drug is created in the tissues of the liver and kidneys. It is excreted from the body with bile and urine.
Rifampicin resistance develops rapidly. Cross-resistance with other antibiotics is not observed (with the exception of rifamycin).
The main indication for use is tuberculosis of the lungs and other organs.
In addition, the drug is used for various forms of leprosy and inflammatory diseases of the lungs and respiratory tract (bronchitis, pneumonia) caused by multiresistant staphylococci, osteomyelitis, infections of the urinary and biliary tract, acute gonorrhea and other diseases caused by pathogens sensitive to rifampicin.
Due to the rapid development of microbial resistance, rifampicin is prescribed for non-tuberculous diseases only when other antibiotics are ineffective.
Rifampicin has a virucidal effect on the rabies virus, inhibits the development of rabies encephalitis; For this reason, it is used for complex treatment rabies during the incubation period.
Rifampicin is taken orally on an empty stomach or administered by intravenous drip (adults only).
Intravenous administration of rifampicin is recommended for acutely progressive and widespread forms of destructive pulmonary tuberculosis, severe purulent-septic processes, when it is necessary to quickly create a high concentration of the drug in the blood, and if the drug is difficult or poorly tolerated by the patient.
The total duration of the use of rifampicin in tuberculosis is determined by the effectiveness of treatment and can reach 1 year.
In the treatment of tuberculosis with rifampicin (intravenously), in patients with diabetes mellitus, it is recommended to administer 2 units of insulin for every 4-5 g of glucose (solvent).
Monotherapy of tuberculosis with rifampicin is often accompanied by an increase in the resistance of the pathogen to the antibiotic, so it should be combined with other anti-tuberculosis drugs (streptomycin, isoniazid, ethambutol, etc.), to which the sensitivity of Mycobacterium tuberculosis is preserved.
Treatment is carried out in combination with immunostimulating agents.
For nontuberculous infections, adults take rifampicin by mouth.
In acute gonorrhea, it is prescribed orally.
For the prevention of rabies, adults are given inside. Duration of application 5 - 7 days. Treatment is carried out simultaneously with active immunization.
Treatment with rifampicin should be carried out under close medical supervision. Allergic reactions (of varying severity) are possible, although they are relatively rare; in addition - dyspeptic symptoms, dysfunction of the liver and pancreas. With prolonged use of the drug, it is necessary to periodically examine the function of the liver and conduct blood tests (due to the possibility of developing leukopenia).
With rapid intravenous administration, blood pressure may decrease, and with prolonged administration, phlebitis may develop.
The drug reduces the activity of indirect anticoagulants, oral hypoglycemic agents, digitalis preparations. With the simultaneous use of anticoagulants and rifampicin, when the latter is canceled, the dose of anticoagulants should be reduced.
The drug has a bright brown-red color. It stains (especially at the beginning of treatment) urine, sputum, lacrimal fluid in an orange-reddish color.
Rifampicin is contraindicated in infants, pregnant women, jaundice, kidney disease with decreased excretory function, hepatitis and hypersensitivity to the drug.
Intravenous administration is contraindicated in pulmonary heart failure and phlebitis.
PYRAZINAMIDE (Pirazinamidum).
Pyrazinecarboxylic acid amide.
Synonyms: Tizamide, Aldinamid, Savizide, Errazin, Farmizina, Isopyrasin, Novamid, Piraldina, Ruracinamide, Rurazinamide, Tebrazid, Tisamid, Zinamide.
More active in tuberculostatic activity than PAS, although inferior to isoniazid, streptomycin, rifampicin, cycloserine, ethionamide, kanamycin, florimycin. It acts on mycobacteria that are resistant to other anti-tuberculosis drugs of the I and II series. The drug penetrates well into the foci of tuberculous lesions. Its activity does not decrease in the acidic environment of caseous masses, and therefore, it is often prescribed for caseous lymphadenitis, tuberculomas and caseous-pneumonic processes.
When treated with pyrazinamide alone, the rapid development of Mycobacterium tuberculosis resistance to it is possible; therefore, it is usually combined with other anti-TB drugs (isoniazid, streptomycin, etc.).
The drug is especially effective in patients with newly diagnosed destructive tuberculosis.
When treating with pyrazinamide, allergic reactions may occur: dermatitis, eosinophilia, febrile reactions, etc. Dyspeptic symptoms, loss of appetite, headache, and occasionally irritability, anxiety are also possible. With prolonged use, it can have a toxic effect on the liver.
During treatment with pyrazinamide, it is necessary to monitor liver function by conducting biochemical tests (thymol test, determining the level of bilirubin, examining serum glutaminoxalate aminoferase, etc.). If changes in liver function are detected, the drug is discontinued. To reduce the toxic effect of pyrazinamide, the appointment of methionine, lipocaine, glucose, vitamin B is recommended.
There is evidence of a delay in the body under the influence of pyrazinamide of uric acid and the possibility of an increase in arthritic pain in the joints; therefore, it is advisable to determine the content of uric acid in the blood.
Contraindications: liver dysfunction and gout.
ETHAMBUTOL (Ethambutolum). (+)-N,N-Ethylene-bis-(2-aminobutan-1-ol), or (+)-N,N-bis-ethylenediimine dihydrochloride.
Synonyms: Diambutol, Miambutol, Afimocil, Ambutol, Anvital, Batacox, Cidanbutol, Clobutol, Dadibutol, Dexambutol, Diambutol, Ebutol, Etambin, Ethambutol, Farmabutol, Li-Butol, Miambutol, Myambutol, Mycobutol, Temibutol, Tibistal, Tubetol, etc.
It has a pronounced tuberculostatic effect, it has no effect on other pathogenic microorganisms. Suppresses the reproduction of mycobacteria resistant to streptomycin, isoniazid, PAS, ethionamide, kanamycin. Well absorbed from the gastrointestinal tract; excreted mainly in the urine.
It is used in the treatment of various forms of tuberculosis in combination with other anti-tuberculosis drugs. There is evidence of high efficacy of ethambutol in combination with rifampicin in patients with chronic destructive pulmonary tuberculosis.
Ethambutol is taken orally once after breakfast.
When taking ethambutol, coughing may increase, the amount of sputum may increase, dyspepsia, paresthesia, dizziness, depression, skin rash may appear, visual acuity may worsen (decrease in the central or peripheral field of vision, formation of cattle). These phenomena usually disappear after discontinuation of the drug (after 2 to 8 weeks).
In the process of treatment, systematic monitoring of visual acuity, refraction, color perception and other indicators of the state of the eye is necessary.
Contraindications: inflammation of the optic nerve, cataracts, inflammatory diseases of the eye, diabetic retinopathy, pregnancy.
ETIONAMIDE (Ethionamidum).
Thioamide of a-ethylisonicotinic acid, or 2-ethyl-4-thiocarbamoyl-4-pyridine.
Synonyms: Thionide, Trekator, Amidazin, Athioniamid, Ethionamide, Ethioniamide, Etionizina, Iridozin, 1314 TH, Nizotin, Rigenicid, Thianid, Thionid, Trecator, Trescatyl, etc.
Ethionamide is a thioamide of isonicotinic acid. It is similar in structure and antibacterial properties to isoniazid, but is less active, at the same time it acts on strains of mycobacteria resistant to isoniazid.
Previously considered as a second-line anti-tuberculosis drug. Currently, its analog protionamide is more widely used (see).
Assign inside and in candles.
The drug is taken after meals.
Ethionamide can be combined with the main anti-tuberculosis drugs, if the sensitivity of mycobacteria is preserved, and also together with cycloserine or pyrazinamide.
Ethionamide is also used to treat leprosy.
When taking ethionamide, dyspeptic disorders can be observed: loss of appetite, nausea, vomiting, flatulence, abdominal pain, loose stools, weight loss. There are also skin rashes such as urticaria or exfoliative dermatitis. Occasionally there is insomnia, depression.
To eliminate side effects, nicotinamide is prescribed.
You can also apply pyridoxine intramuscularly. Patients with low acidity of gastric juice when taking ethionamide should take hydrochloric (hydrochloric) acid diluted or gastric juice, and when hyperacidity- antacids.
Ethionamide should be used with caution in diseases of the gastrointestinal tract and liver.
For effective treatment and preventive measures, anti-tuberculosis drugs are used - specific antibacterial agents intended for chemotherapy in patients with consumption.
Funds classification
At various forms pathological process, drugs for pulmonary tuberculosis are used, which 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 substances (basic) are prescribed for therapy:
- Rifampicin;
- Pyrazinamide;
- Isoniazid;
- Ethambutol;
- Streptomycin.
In the event of the appearance of resistant forms of the causative agent of tuberculosis and the absence of the effect of treatment, the patient is prescribed second-line drugs (reserve):
- Ethionamide;
- Cycloserine;
- Amikacin;
- Capreomycin.
- Ofloxacin;
- Levofloxacin.
If the disease has gone too far, it is advisable to include in the list necessary funds bacteriostatic agents:
- Ethionamide;
- Terizidone.
Group 5 drugs include 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 choose the necessary drugs.
After the diagnosis, taking into account the symptoms of the disease, the patient is put on a dispensary record. 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, excreting bacteria into environment. The chronic course of the disease of any localization is 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 persist. Patients are under medical supervision.
A fairly common phenomenon is the contact of a person with a source of tuberculosis infection. The patient needs to visit the doctor regularly to identify the primary infection. Children and adolescents with a tuberculin test turn are regularly examined by a phthisiatrician.
Treatment of lung disease is carried out in compliance with the basic principles:
- early use of effective chemotherapy;
- complex use of drugs;
- prescribing drugs, taking into account the characteristics of the pathogen;
- regular monitoring of the therapy process.
The patient is prescribed specific, pathogenetic and symptomatic treatment.
life-saving drugs
Tuberculosis tablets destroy sensitive mycobacteria, so they are used in the intensive care phase 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) to patients in whom tuberculosis is first detected.
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 drugs of the 1st line against tuberculosis - Isoniazid, Pyrazinamide and Ethambutol. The course of therapy lasts 5 months.
The treatment regimen for tuberculosis is recommended for patients who have interrupted therapy or are undergoing a second course. If the resistance of the causative agent of tuberculosis is diagnosed, daily doses of drugs are prescribed in 1 dose to establish their high concentration in the 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 drug is set taking into account the age and weight of the patient; children and adolescents are prescribed the drug for medical reasons.
Combined funds: advantages and disadvantages
Treatment of pulmonary tuberculosis in adults is carried out with drugs designed to control their intake and prevent overdose. Combined anti-tuberculosis drugs include 3-5 components.
In outpatient practice, the following drugs are used:
- Refinag;
- Phthisoetam;
- Rimkur;
- Protiocomb.
The main components of the combined drugs are isoniazid, ethambutol, vitamin B6. Lomecomb medicine consists of 5 ingredients that affect the course of an acute process.
Combined drugs are prescribed for patients with tuberculosis, detected for the first time, as well as with pronounced resistance to isoniazid and rifampicin.
In the tuberculosis dispensary, therapy is carried out with the help of drugs Lomecomb and Protiocomb, which increase the effectiveness of treatment in the event of a progressive form of the disease. Main disadvantage combined substances - presence side effects.
Reserve medicines
If it was not possible to achieve the effect of treatment with 1st line drugs, the patient is prescribed reserve funds:
- Cycloserine;
- Ethionamide;
- Kanamycin;
- PASK.
Their use gives a good result in the treatment of the disease.
For the treatment of resistant dosage forms, Levofloxacin from the group of fluoroquinolones is used. The daily dose is set individually for each patient, taking into account the characteristics of the pharmacokinetics of the drug. If the patient does not tolerate Levofloxacin, Avelox is prescribed - an antibiotic with a universal effect.
Treatment of the intensive phase of pulmonary tuberculosis is carried out with the help of combined agents that cause the development of side effects. Levofloxacin is prescribed simultaneously with drugs that eliminate its side effects on the nervous system.
PASK provides bad influence to the stomach and intestines. The patient is recommended to drink the medicine with water mixed with cranberry juice. Reception of PASK is canceled if the patient has pain in the joints.
Side effect
The doctor monitors concomitant reactions during treatment chemicals. The patient is prescribed blood and urine tests, determine ALT and AST in the blood, the presence of creatinine, recommend a doctor's examination during treatment with aminoglycosides.
Side effects of anti-tuberculosis drugs are manifested by unpleasant symptoms. Isoniazid causes headache, irritability, insomnia. The patient is affected by the optic nerve, there are palpitations, pain in the heart, symptoms of angina pectoris. 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 eruptions, 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 blood in the urine.
How to take drugs
For the treatment of pulmonary tuberculosis, a specific therapy regimen is prescribed. The medicine is taken at a 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 therapy is carried out for 9-12 months.
Levofloxacin is prescribed in case of resistance of the pathogen to the 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 diseased kidneys. The drug 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 drip. 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 when treated 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.
Dorogov's Stimulant Therapy
If resistance to 1st and 2nd line drugs has developed, some patients use non-traditional therapies. With pulmonary tuberculosis, the ASD preparation has proven itself to be excellent - 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 amount 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 scheme. 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 an unstable psyche, uncontrolled arousal occurs. In this case, the drug is canceled.
Fraction is contraindicated for pregnant and lactating 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 the effective medicine SQ109, used to treat patients with pulmonary tuberculosis. After its use for 6 months, it is possible to stop the release of the pathogen into the environment. The drug is safe and well tolerated by patients. SQ 109 is prescribed during combination therapy in combination with Isoniazid, Bedaquiline and Ampicillin.
New anti-tuberculosis drugs are second-line drugs and have an antibacterial effect. The patient is prescribed drugs:
- bedaquiline;
- Linezolid;
- Sparfloxacin;
- Ethionamide.
New anti-tuberculosis drugs help to successfully fight primary or secondary drug resistance of Mycobacterium tuberculosis. Among the new drugs for tuberculosis, BPaMZ and BPaL drugs used to treat tuberculosis of various localizations have an effective effect. BPaL is used to treat disease caused by resistant forms of the pathogen.
New anti-tuberculosis drugs are undergoing clinical trials and significantly reduce the duration of therapy. The drug Protiocomb several times reduces the number of tablets needed to be taken during the day, and its effectiveness is not inferior to the action of monopreparations.
Alcohol compatibility
Patients who abuse alcohol often develop tuberculosis. Treatment of a drinking person is long, accompanied by severe complications. With alcohol dependence, a patient with tuberculosis is prescribed drugs such as:
- Streptomycin;
- PASK;
- Rifampicin.
If during treatment the patient allows himself a small dose of alcohol, after taking the medicine, gastritis often develops, and the load on the liver increases.
Amikacin in combination with alcohol causes nausea and vomiting. Symptoms of depression of the nervous system occur after the simultaneous administration of the antibacterial agent Amikacin and strong alcoholic beverages. A bad habit and unauthorized termination of treatment often lead to a decrease in the body's defenses, the development of a cavernous form of tuberculosis.
The combination of the following drugs with alcohol is extremely dangerous: Rifadin, 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, 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 gastric and duodenal ulcers, glomerulonephritis, nephrosis, and hypothyroidism.
In the vast majority of cases, Amikacin is not recommended for patients suffering from pathology of the organs of vision and hearing, renal failure.
Sometimes patients complain of an allergic reaction during treatment with anti-tuberculosis drugs.
- Tavegil;
- Diazolin;
- Zaditen.
Ciprofloxacin is not prescribed for the elderly, pregnant women, with increased sensitivity to the drug. In TB dispensaries, infusion therapy begins with a jet injection of an antibiotic.
- thrombophlebitis;
- hypertension II and III degree;
- diabetes mellitus;
- hemorrhagic diathesis;
- circulatory insufficiency II and III degree.
During lactation, Rifampicin and drugs from the fluoroquinolone group are contraindicated.
Preventive action
The patient is taking pills to prevent tuberculosis. Streptomycin is prescribed for pregnant women, patients suffering from pathologies of the brain, kidneys, and heart. In children and adults, tuberculosis is prevented with the help of Metazid. 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 a broad-spectrum antibiotic. Cycloserine is taken as prescribed by a doctor. The drug is contraindicated in people with mental disorders who abuse alcohol.
A drinking patient has a headache, tremor, disorientation, increased irritability. While taking an antibiotic, care must be taken, because. The patient may experience seizures. In this case, the patient is prescribed sedative and anticonvulsant drugs.
The success of the treatment of pulmonary tuberculosis depends on the exact implementation of the doctor's recommendations and adherence to the therapy regimen.
Tuberculosis belongs to the group of infectious diseases. The causative agent is a type of mycobacterium with high viability. They do not manifest themselves for a long time, being activated during favorable conditions. According to statistics, a third of the world's population is a carrier of Koch's wand. A universal cure for tuberculosis has not been invented, and the problem of epidemics in a number of countries remains unresolved. However, existing drugs for the treatment of tuberculosis help to reduce the incidence rate.
Infection occurs as a result of a sharp decrease in immunity. The development of the disease is provoked by low living conditions, malnutrition, chronic pathologies. Most often, mycobacteria affect the respiratory system. But they also apply to the digestive, skeletal and other systems of the body. Depending on this, appropriate drug treatment of tuberculosis is prescribed.
What are anti-tuberculosis drugs
The effectiveness of recovery is determined by a set of measures. First of all, it includes medicines for tuberculosis. These chemotherapy drugs are used for both treatment and prevention of the disease. Tuberculosis drugs are divided on the basis of their clinical effectiveness into groups:
- The main means of high activity - against mycobacteria with low toxicity.
- Reserve funds - drugs for tuberculosis, for a multidrug-resistant type of disease.
Anti-tuberculosis drugs prevent the growth and reproduction of bacteria. At a certain concentration, some destroy the pathogen. The drug for pulmonary tuberculosis is selected taking into account the form of the disease and the resistance of mycobacteria to a particular drug.
Photo 1. Mycobacterium tuberculosis has an oblong shape, which is why they are also called tuberculosis bacillus.
Types of medicines for tuberculosis
The treatment regimen includes funds belonging to one of the groups. The international classification refers to the first group effective drugs against tuberculosis. They are prescribed to prevent relapse, for prevention. Their use began in 1952.
Isoniazid
The mechanism of action is based on the fact that the drug blocks the synthesis of mycolic acid, preventing the propagation of the infection. Active against intracellular and extracellular bacteria. It is considered an effective drug against tuberculosis. Helps to cope with the disease at any age, used for treatment and prevention. The drug is contraindicated in patients with epilepsy, atherosclerosis, poliomyelitis.
A popular drug against tuberculosis, it is highly active in the lesion. After ingestion, rapid absorption occurs. active ingredient. It is concentrated in sputum, kidneys, liver, lungs. The risk of getting into breast milk does not allow the use of the drug during lactation. Rifampicin should not be used if the patient has a diseased liver.
Photo 2. Rifampicin is a broad-spectrum antibacterial agent used in anti-tuberculosis therapy.
Pyrazinamide
The bactericidal effect of this drug for the treatment of pulmonary tuberculosis is less pronounced. However, it has a sterilizing effect, manifesting itself in the focus of infection. Affects slowly multiplying bacteria depending on their resistance. It is prescribed for any form of the disease. Prohibited in liver failure.
An effective drug for the treatment of tuberculosis with a bacteriostatic effect. The active substance ethambutol hydrochloride is absorbed from the gastrointestinal tract and excreted through the kidneys. The treatment course lasts 9 months and consists of several stages. The initial dosage is 15 mg per kilogram of the patient's weight. Take Ethambutol once a day. Gradually increase the dose to 30 mg per kilogram of body weight. In patients with renal insufficiency, the drug is prescribed depending on the indicators of creatinine clearance. Contraindications for use are gout, diabetic retinopathy, pregnancy. Reception of Ethambutol can lead to a decrease in vision, it is not recommended for use in cataracts, inflammatory processes in the eyes.
Photo 3. Ethambutol is used in the treatment of tuberculosis because it has a strong bacteriostatic effect on the causative agent of the disease.
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Streptomycin
Broad spectrum antibiotic. It is prescribed by a doctor, taking into account the characteristics of the course of the disease. The duration of the therapeutic course is determined on an individual basis. The maximum daily dosage of a drug for the treatment of pulmonary tuberculosis is 4 grams. Contraindications for use: renal failure, cardiovascular disease, myasthenia gravis, brain disorders. Patients with tuberculosis, pregnant and lactating women are prohibited from taking Streptomycin.
The range of drugs for tuberculosis, included in the second, reserve, group, is wider. They are prescribed when it is impossible to use drugs from the first group and when the previous therapy did not give a positive result.
Photo 4. Streptomycin, a broad-spectrum antibiotic, is used in the treatment of tuberculosis diseases in the form of injections.
Cycloserine
Used for over half a century. To date, the tool is obtained synthetically. The drug has a bactericidal and bacteriostatic effect. It is highly absorbable, which allows it to quickly reach its maximum concentration in body fluids and tissues. Able to pass into breast milk. For this reason, it is contraindicated during lactation and pregnancy. Forbidden to children. Taking medication for tuberculosis in adults causes headaches, drowsiness, and irritability appears. In mild forms of tuberculosis, the drug is prescribed at any stage of the disease.
Photo 5. The antibacterial agent Cycloserine retards the growth of tuberculosis pathogens resistant to other drugs.
Kanamycin
A popular drug with high activity against bacteria different kind. Scheme of application for tuberculosis: for adults - 1 g per day once for six days, for children - 15 mg per day. On the seventh day - a break. The duration of the course and its duration is determined by the doctor. Do not prescribe Kanamycin in combination with antibiotics with nephrotoxic and ototoxic effects. The drug is contraindicated for people with hearing problems, diseases of the digestive system and pregnant women.
Photo 6. Kanamycin solution is used to treat drug-resistant tuberculosis disease.
Metazid
A derivative of isonicotinic acid hydrazide. The mechanism of action of this agent is the ability to damage the membrane of pathogenic bacteria, causing their death. Daily dose is 2 g of the drug for adults and 1 g for children. It is divided into 2-3 doses. The medicine is used for any form of tuberculosis. It is forbidden for patients who have diseases of the central nervous system, renal failure, heart disease. In the process of undergoing treatment for tuberculosis, check the condition of the fundus.
Photo 7. Metazid has a bactericidal effect against actively multiplying Mycobacterium tuberculosis.
Ethionamide, Prothionamide
The structure of these drugs is largely similar. Having a bacteriostatic effect in the lesion, they inhibit the reproduction of tuberculous mycobacteria. The drugs are used in the treatment of patients older than 14 years. The ability of drugs to pass into breast milk has not been established. To prevent the occurrence of undesirable consequences, drugs are not used during lactation.
Photo 8. Prothionamide is available in the form of tablets, used in conjunction with other anti-tuberculosis drugs.
Thioacetazone
Synthetic antibiotic effective against tuberculosis. Take it exclusively after meals, with plenty of water. During treatment, it is important to control the activity of the kidneys. If agranulocytosis is detected, stop taking the drug. Thiocetasone should not be used to treat tuberculous meningitis.
| P reparations | Daily intake | Reception 2 times a week | Maximum daily dose | |||
| Children | adults | Children | adults | Children | adults | |
| Isoniazid | 10-20 mg/kg | 5 mg/kg | 20-40 mg/kg | 15 mg/kg | 0.3 g | 0.3 g |
| 10-20 mg/kg | 10 mg/kg | 10-20 mg/kg | 10 mg/kg | 0.6 g | 0.6 g | |
| Streptomycin | 20-40 mg/kg | 15 mg/kg | 25-30 mg/kg | 25-30 mg/kg | 1 g | 1 g |
| 15-25 mg/kg | 15-25 mg/kg | 50 mg/kg | 50 mg/kg | 2.5 g | 2.5 g | |
The table shows the dosages of anti-tuberculosis drugs depending on the age category of the patient and the chosen tuberculosis strategy.
Features of the use of drugs for tuberculosis
An integrated approach will ensure a complete recovery. Drug treatment of tuberculosis is accompanied by measures that are aimed at strengthening immunity. The therapeutic complex implies that many effective drugs for tuberculosis will be used. Drugs have certain actions that help to cope with the disease more effectively. Medications for tuberculosis should not be interrupted in order to avoid the development of resistance of the pathogen to the drug. A full course of treatment is carried out, in which compliance with the medication regimen is important.
Photo 9. In the treatment of tuberculosis, it is important to strictly observe the regimen of taking anti-tuberculosis drugs.
Side effects of TB drugs
Drugs for the treatment of pulmonary tuberculosis are toxic. Most of them cause various side effects. These are both toxic complications and an allergic reaction. In the first case, the duration of treatment, dosage, individual characteristics of the body matter. After taking the medicine, there is a deterioration in the patient's condition, disruption of work internal organs. Allergic manifestations are more often observed after preim antibacterial agents. Expressed in the form of rashes on the skin, itching, rhinitis, Quincke's edema. Anaphylactic shock, which can be fatal, is especially dangerous. Allergic reaction occurs in response to an antigen drug and metabolic products. Uncontrolled intake of anti-tuberculosis drugs can undermine human health.
Photo 10. Itchy skin may be a symptom of an allergy to an anti-tuberculosis drug taken by the patient.
It is possible to avoid the negative consequences of taking drugs. Treatment is carried out under the supervision of a doctor who conducts an anamnesis and a complete examination, taking into account laboratory tests, fluorography. They are made by any polyclinic or tuberculosis hospital. After that, it is determined which drugs to treat tuberculosis in a particular case. Based on the clinical course of the disease, a treatment regimen is built. The drugs are prescribed in small doses, which increase over time. Any folk remedy for tuberculosis will help minimize the side effects of chemical medications. When choosing it, a consultation with a phthisiatrician is required.
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. Not used when breastfeeding, because it has the property of in large numbers pass into breast milk.
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 independent form 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 that have 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 metabolic processes that occur in the patient's body, and also cause the development of hypo- or beriberi, violations 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 - folk remedies from 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.