Treatment of Tuberculosis

Tuberculosis is a disease which can be completely cured by appropriate treatment. Antibiotics developed specifically against the TB causing bacterium (mycobacterium tuberculosis), are used in the treatment. It has been proven that the use of a single antibiotic for TB treatment can result in development of antibiotic resistance to the drug. Hence 4 to 5 drugs are used in a combination for treatment. Generally people undergoing treatment for the first time for TB need 6 months duration of treatment. The drugs are available free of cost at all government health centres. The usual first line drugs in use are Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. Rarely some adverse effects are noted in patients on antitubercular drugs. Nausea, vomiting, abdominal pain are the common side effects, but rarely liver enzymes rise in some individuals. Blood tests conducted at regular intervals will detect this early enough and necessary changes in the drugs can reverse this situation. Numbnes of extremities and colour blindness are also seen rarely as adverse effects of drugs. In those patients who require retreatment for TB, streptomycin injection used to be included previously.But the latest national guidelines advise using this drug only under special circumstances. This drug can rarely cause hearing impairment in some individuals. Most of the adverse effects of TB drugs are reversible with appropriate and timely changes in the drugs. 

Treatment of MDR TB 

 When the bacteria attain resistance to the first line antitubercular drugs, Multi drug resistant TB results. If the disease doesn't get improved with 6 months of treatment with first line anti tubercular drugs, MDR TB is to be suspected. But presently tests are available to detect resistant TB early enough. The duration of treatment of MDR TB is generally 2 years, but shorter regimens are also available now. The drugs used in the treatment of MDR TB are Kanamycin, Levofloxacin, Ethambutol, Pyrazinamide, Ethionamide and Cycloserine. The type of resistant disease which does not respond to these 2nd line drugs is called XDR (extensively drug resistant) TB. This also requires treatment of longer duration of almost 2 years. Newer drugs like Bedaquiline and Delamanid are now available for treatment of resistant TB cases. An expert medical panel decides the need for these drugs after careful examination of the patient and the clinical details. 

 Prevention 

Since Pulmonary TB spreads easily to others, the first and foremost preventive measure is early detection and treatment of TB cases. Usually within 2 weeks of treatment with appropriate anti TB drugs, the patient will stop spreading the disease. Appropriate disposal of the infective sputum of such patients is also equally important. Sputum should not be disposed in open spaces or public places. Whenever the patient visits public places or hospitals, masks are to be worn to reduce the risk of transmission to others. Its ideal to avoid public transportation and crowded public events in the initial months to reduce the transmission. The bacteria usually disappear from the sputum after 2 weeks of correct treatment. 

The patient should spit his sputum only to a covered sputum cup. This cup can be pre - poured with 5% phenol/cresol/ sodium hypochlorite solution for disinfection. Or hot water can be poured to the cup before disposal to disinfect the sputum. If the patient spits to a thick paper or cardboard, this can be burnt as a disposal method.

  BCG

In a country like India where the infection rates of tuberculosis are high, BCG vaccine should be given to all infants. This offers protection from childhood TB and from complications of TB like disseminated TB and TB meningitis. The duration of protection is estimated to be 15 to 20 years.

Children who live with adults suffering from pulmonary TB may require preventive drugs for 6 months. Isoniazid is the drug used for such prophylaxis. Such preventive drug is also given to infants who are breastfed by mother suffering from tuberculosis. Women who take drugs for tuberculosis should use contraceptive methods prescribed by the doctors. This is because some antitubercular drugs may cause adverse health events in the foetus.

Newer Challenges

Inspite of being an ancient disease and despite availability of effective anti TB drugs, tuberculosis still continues to be a major public health threat globally. There are multiple reasons for the same. In the western countries, with improved quality of life and better nutrition, incidence of TB had sharply declined. Presently a slight increase in the TB cases is noted in these countries. One of the reasons for this probably may be the immunosuppressive condition like HIV. TB cases are also on the rise in countries with high prevalence of diabetes mellitus. In underdeveloped countries, crowded houses, inferior quality of life and malnutrition result in higher TB incidence.

Several initiatives are going on across the globe to end the TB epidemic. 'The End TB strategy' by World Health Organization is one of those initiatives and countries like India have adopted strategies from this in our policy making process.

Spreading awareness, political will in health policy formulation and research can eventually result in eradicating the disease from the face of earth.