Treatment of pulmonary tuberculosis requires a long-term, comprehensive approach. For this purpose, special chemotherapy has been developed based on several components.
General rules
Treatment of pulmonary tuberculosis in adults should be carried out with several medications and without interruption. As a rule, the scheme uses 4-5, which must be taken every day for six months.
The active ingredients have different effects on mycobacteria, and only in combination is it possible to completely destroy mycobacteria. In addition to this, in mandatory immunomodulatory drugs are prescribed.
Breathing exercises and physiotherapy are also necessary. Otherwise, mortality can reach up to 50% in the active form. The second 50%, if left untreated, become a chronic disease.
Treatment of such a disease must be carried out under the supervision of a doctor - self-medication can lead to resistance of mycobacteria and a more advanced stage.
Algorithm of actions
How is pulmonary tuberculosis treated in adults? Recovery requires the implementation of certain goals:
- Eliminate laboratory signs and clinical manifestations of the disease.
- Restore human performance.
- Stop the release of mycobacteria into the environment, which must be confirmed by laboratory tests.
- Eliminate various signs diseases with confirmation of their absence by an x-ray procedure.
Attention! If it is not possible to carry out a full course, it is better to postpone therapy than to interrupt it. All medications must be taken daily without a break.
Where is therapy performed?
Treatment of pulmonary tuberculosis in adults is carried out throughout long period with mandatory medical supervision at every stage.
Surgical intervention
A significant number of patients with various types of Mycobacterium tuberculosis require surgery– cutting off the source of inflammation lung tissue.
Surgical treatment of pulmonary tuberculosis is necessary in the following cases:
- There are cavities that can release phlegm and spread bacteria. Wherein conservative treatment for 3-6 months did not bring success. In some cases, dangerous bleeding from cavities is possible. Large cavities are formed, due to which cavities cannot be scarred on their own, which leads to an even greater spread of infection and possible relapses.
- There are foci of inflammation without mycobacteria. Prescribed drugs cannot sterilize these lesions due to their inability to penetrate fibrous tissue.
- The presence of cicatricial strictures of the bronchi after the lesion.
- Foci of infection caused by atypical mycobacteria that are not amenable to drug treatment.
- Complications in the form of accumulation of pus in pleural cavity or collapse (low blood pressure) of the lung.
- The development of neoplasms of unknown etiology (the cause of the disease).
Surgical intervention is necessarily combined with enhanced therapy with anti-tuberculosis drugs. If treatment is incorrect, a treatable stage may develop into a difficult-to-treat condition due to drug resistance.
In addition to resection ( complete removal) lung, drainage (suction of fluid) of the pleura or lung tissue caverns is possible, as well as the use of artificial pneumothorax (accumulation of air).
Three component circuit
At the time when anti-tuberculosis therapy first appeared, the following scheme for combating the disease was formed:
- Streptomycin.
These substances have been used to treat pulmonary tuberculosis for decades, helping to save many lives.
Four component circuit
With the start of active medical care, strains (genus of viruses) of mycobacteria have become more resistant to medications. Next step was the development of four-component first-line therapy:
- Streptomycin/kanamycin;
- Rifabutin/;
- Isoniazid/ftivazid;
- Pyrazinamide/ethionamide.
Interesting! Such principles for combating the disease were developed by the Dutch doctor Karel Stiblo in 1974. 20 years later, the World Health Organization recognized Stiblo's tuberculosis control model, calling it the DOTS strategy and recommending it for countries with high level incidence of Mycobacterium tuberculosis.
Some experts believe that the Soviet strategy for treating pulmonary tuberculosis was more effective and comprehensive using anti-tuberculosis dispensaries, compared to Dr. Stiblo's methods.
Five component circuit
Today, many experts prefer to enhance the regimen with an additional fluoroquinolone-based substance, for example, ciprofloxacin. Given the rise in drug-resistant diseases, treatment is becoming an increasingly complex issue.
Therapy includes antibiotics of the second, third and later generations. The effectiveness of such drugs occurs after daily use for 20 months or longer.
However, the cost of second- and higher-generation antibiotics is much more significant than the first-line course. Moreover, already side effects from such medications they occur more often.
Even with four or five component regimens, mycobacteria can exhibit resistance. Then, to eliminate pulmonary tuberculosis, treatment switches to second-line chemotherapy drugs - such as capreomycin, cycloserine.
Inflammation with Mycobacterium tuberculosis and the treatment method itself can lead to secondary diseases - anemia, hypovitaminosis, leukopenia. Therefore, attention should be paid to a varied diet, especially if there is significant weight loss.
Patients whose medical history is aggravated by narcotic or alcohol addiction, undergo cleansing of toxins before starting anti-tuberculosis therapy.
If there are diseases other than MBT for which immunosuppressive therapy is used (suppression adverse reaction immunity), then either it is canceled altogether, as far as the clinical picture allows, or the dosage is reduced.
HIV-infected people should undergo anti-HIV therapy in parallel with anti-tuberculosis therapy.
Glucocorticoids
These drugs have a pronounced immunosuppressive effect. Therefore, their use is extremely limited.
The indication for the use of glucocorticoids (steroids) is severe intoxication or acute inflammation. They are prescribed for a short-term course in small doses and always during five-component chemotherapy.
Related Methods
An important element of therapy is Spa treatment. The thin air in the mountains facilitates oxygenation of the lungs, thereby reducing the growth and increase in the number of mycobacteria.
For the same purposes, hyperbaric oxygenation is used - the use of oxygen in special pressure chambers.
Additional Methods
Previously, in cases where the cavity did not shrink due to thick walls, the only solution was surgery. Nowadays, the method of valve bronchial blockade is more effective.
Its essence is that an endobronchial valve is introduced into the affected area, which allows you to preserve drainage function bronchus and create hypoventilation. The valve is installed through the larynx using local anesthesia(anesthesia).
The method has not yet received the widespread popularity it deserves due to the high cost of the equipment, and is also not independent - such operations are carried out in parallel, and not instead of chemotherapy.
Initial stage of the disease
Important. For a successful result it is necessary timely diagnosis. There are various laboratory methods to determine infection and morbidity.
How is early stage pulmonary tuberculosis treated? If thanks to correct assessment clinical picture(long period of time, coughing, enlarged lymph nodes, nausea, weakness, pallor, general decline immunity, sudden loss weight) and carrying out x-ray examination The specialist makes a diagnosis of tuberculosis, then by adequate treatment, results can be achieved in 6 months, less often – in two years.
As a rule, the following drugs are used for the initial stages:
- Pyrazinamide;
- Streptomycin;
- Rifampicin.
But the dosages of these drugs differ from case to case. late stages and must be assigned individually. It is important, which must include fresh vegetables and fruits, whole grain bread, bran, jacket potatoes, eggs, milk.
As a supplement, you can refer to folk medicine. Treatment of pulmonary tuberculosis can be achieved not only with the help of medications.
Herbs and infusions will be an excellent addition to treatment
- Marshmallow root infusion;
- Decoction of coltsfoot leaves;
- Ledum infusion;
- Decoction of pine cones.
Each plant has its own dosage and frequency of administration.
Prevention
TO preventive methods includes maintaining overall health (various exercise stress and proper nutrition), exception bad habits(smoking, alcohol and drug addiction). An important factor is good social and living conditions.
We present to your attention an interesting educational film about tuberculosis. Be sure to watch it if you are unfamiliar with the disease.
Improving working conditions, combating pollution environment, avoiding communication with patients are also prevention-oriented measures.
Tuberculosis or consumption can creep up unnoticed and unexpectedly. Gone are the days when this infectious disease exclusively affected people who antisocial image life, eating poorly, 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 could become long-term stress, poor nutrition, absence physical activity on fresh air. An illness that begins with a slight cough and malaise, which you, of course, attribute to stress and a slight cold against a 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 is becoming the lot of doctors in 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 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. Primary focus inflammation is activated when the body’s defenses decrease, 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 express yourself.
initial stage
Symptoms that indicate a person has initial stage 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 listed items, you must urgently contact the nearest medical facility and have a 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 with connective tissue that is not responsible for the exchange of oxygen in the lungs.
The focus can be located in the lungs and pleura, that is, the respiratory organs; symptoms of respiratory tuberculosis are 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. In addition, correctly selected treatment, the patient’s social and living conditions, the presence of bad habits, and intolerance to certain medications are of high importance. Even with timely appointment proper treatment, factor complete cure largely depends on the resistance abilities of the body. 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. At 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 of the treatment of tuberculosis in children is careful monitoring during the procedure 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 medicines 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 infection and worsening of the situation, constant monitoring of the condition and adjustment, monitoring 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 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.
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, when organized proper nutrition, modes 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 TB specialists, if the disease takes a drug-resistant 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. Exception pathogenetic treatment and limitation by 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 if early diagnosis, prescribing chemotherapy and following social and household 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), a decoction of pine buds (pour 1 teaspoon of buds into a glass of boiling water and hold in a water bath for 15 minutes, infuse for 1 -1.5 hours).
Also prescribed for tuberculosis fish fat Take a teaspoon 3 times a day before meals. 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 increased oxygenation (high oxygen content in the air), which prevent the spread of mycobacteria, and also give new strength to the body to fight infection. Don't forget that proper balanced nutrition also cures tuberculosis patients, as does fresh air.
Tuberculosis treatment regimens should be understood as various drug combinations, their dosages and duration of use, as well as methods of administration ( orally, intravenously, intramuscularly).
Treatment of such patients is possible only in an anti-tuberculosis hospital, where they will be constantly under the supervision of doctors.
Duration of treatment at least 12 months.
Treatment regimens for pulmonary tuberculosis
Tuberculosis treatment is always carried out according to established standards. To treat the disease, chemotherapy drugs are used, which differ in efficiency and safety.
To simplify the administration of therapy and prevent the development of resistance of mycobacteria, special schemes. They are prescribed depending on the type of disease identified, the resistance of the pathogen and other indications.
4 treatment regimens for tuberculosis
In all treatment regimens there are intensive phase and continuation of treatment. The first lasts from two months and is aimed at achieving remission. In this case, they usually use the most strong remedies. The continuation phase is carried out with drugs that are chosen based on how effective the active treatment was. Its goal is primarily to consolidate the achieved state of remission and prevent exacerbation of tuberculosis.
1 chemotherapy system for primary patients
This treatment regimen is indicated apply to patients:
- with newly diagnosed tuberculosis and the presence of mycobacteria in sputum;
- without isolation of the pathogen, with forms of the disease such as disseminated tuberculosis and pleurisy.
The intensive phase lasts two to three months until the sensitivity and resistance of mycobacteria are determined using laboratory methods.
It is based on the use of 5 drugs: Rifampicin, Isoniazid, Streptomycin, Pyrazinamide and Ethambutol.
Important. Every year people die from tuberculosis 3 million Human. This is more than AIDS, malaria, diarrhea and all tropical diseases combined.
During the intensive phase, the patient must take orally at least 60 doses chemotherapy drugs in a prescribed combination. In cases where the patient misses taking the medication for one reason or another, the due date is shifted by one day. In any case, he must take all the doses prescribed to him.
The transition to the continuation phase is considered to be the cessation of the release of mycobacteria, improvement in the general condition of the patient, and a decrease in the severity of clinical and radiological manifestations of the disease.
If after 60 days treatment, the sensitivity of the pathogen to first-line drugs remains, then the medication is continued within 4 months. The patient at this time 120 doses of Isoniazid and Rifampicin are prescribed. The use of medications can be daily or intermittent, that is, once every two days. An alternative is combination of Ethambutol with Isoniazid, which should be taken for six months.
Photo 1. The photo shows anti-tuberculosis drugs for intravenous and oral administration and a disposable syringe.
2nd treatment option for patients with relapse
Highlight two schemes such anti-tuberculosis therapy:
- 2a- indicated for patients with relapse diseases and patients who received inadequate treatment more than a month. for example, it is used by people who were treated with the wrong combination of chemotherapy drugs or did not receive enough drugs. At the same time, the likelihood of drug resistance should be low;
- 2b- used to treat patients with a high risk of developing MBT drug resistance. These are people who have been in contact with bacteria, who do not have a permanent place of residence, people with concomitant diseases and others.
Each of these schemes has distinctive features.
2a diagram
During the intensive phase, the following is recommended:
- during the first two months of fixed assets - Rifampicin, Ethambutol, Isoniazid along with Pyrazinamide and Streptomycin;
- in the third month - the same drugs except Streptomycin.
During the entire intensive phase the patient receives 90 doses four main drugs against tuberculosis and 60 doses Streptomycin. If after three months of therapy the sensitivity of the pathogen remains, then the use of 150 doses Isoniazid, Rifampicin, and Ethambutol. You can use them daily or in three times every 7 days.
If, at the end of the intensive phase, bacterial excretion continues, as determined by bacterioscopic examination of sputum, or bacterial resistance to drugs is determined, it is necessary to change the chemotherapy regimen. In this case, the patient continues to take medications, the effectiveness of which is preserved, but they are additionally prescribed backup medications. The duration of the course increases by 60-90 days.
In most cases, this treatment regimen is carried out within nine months. If multidrug resistance of the pathogen is determined, the patient is transferred to the IV option of chemotherapy.
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2b diagram
In this case, during the intensive phase of treatment, it is added to the treatment regimen. Kanamycin and Fluoroquinolone.
The continuation phase is determined based on the results of mycobacterial resistance studies.
If multiple resistance of MBT to such agents as Rifampicin or Isoniazid, a transfer to the fourth chemotherapy regimen is indicated.
3 way of active therapy
A third chemotherapy regimen is used to treat first identified pulmonary tuberculosis without isolation of mycobacteria. To prescribe it, the patient’s lung tissue damage should not exceed an area equal to two segments.
The intensive phase usually lasts two month. At this time, first-line therapy drugs are used: Isoniazid, Pyrazinamide, Rifampicin and Ethambutol. Total used 60 doses medicines.
Sometimes after 60 days treatment fails to determine the sensitivity of mycobacteria to chemotherapy. In such cases, continued therapy is indicated until this information can be obtained.
The continuation phase of treatment begins when there is a pronounced positive trend in clinical and radiological manifestations. In such cases, the use of Isoniazid and Rifampicin in the following modes:
- 120 doses for four months every day;
- The same amount of drugs in intermittent mode - 3 times a week.
Also in the continuation phase of treatment can be used Ethambutol and Isoniazid within six months. The total duration of chemotherapy during the third treatment regimen is 6-8 months.
The fourth order of treatment for tuberculosis with resistant microbacteria
This chemotherapy is indicated for patients who secrete a lot drug-resistant mycobacteria. Therefore, before starting medication in a patient, the sensitivity of MBT should be determined. To do this, it is better to use express methods, for example, BACTEC system.
Photo 2. Appointment with the doctor, a photo of the lungs in the background. The doctor has a sterile mask on his face.
Based on the results of data on the drug sensitivity of Mycobacterium tuberculosis, an individual chemotherapy regimen is selected.
Reference. Treatment is carried out only in specialized anti-tuberculosis hospital. This is due to the fact that it is necessary carefully control what are the results microbiological research, and the effectiveness of therapy.
Drugs indicated for the treatment of patients with drug-resistant MBT include:
- Kanamycin;
- Cycloserine;
- Capreomycin;
- fluoroquinolones and other reserve anti-tuberculosis drugs.
The duration of the intensive phase is six months. At this time, a combination of drugs consisting of at least five drugs is used. Basic drugs can be added to reserve anti-tuberculosis drugs in cases where mycobacteria remain sensitive to them.
The use of anti-tuberculosis drugs in the intensive phase is indicated until positive clinical and radiological dynamics appear, as well as at least two negative results during bacteriological examination of sputum.
Along with the use chemotherapy funds can be used surgical methods, for example, artificial pneumothorax. This allows you to significantly speed up the process of remission of the disease.
The continuation phase of treatment begins when the patient becomes stabilization of the disease, bacterial excretion stops according to culture and microscopic examination of sputum. At the same time, it is necessary that positive dynamics be noted according to clinical data and the results of X-ray examination.
During this period, a combination is used consisting of at least three anti-tuberculosis drugs, including the main ones to which sensitivity is preserved. Duration of medication use - more than 12 months.
Useful video
Do I need to undergo fluorography annually? Every year, there are 9 million cases of tuberculosis infection and 3 million cases of tuberculosis worldwide. fatal outcome. The video shows how this disease is treated in a scientific and practical center.
Conclusion
Choosing a chemotherapy regimen for tuberculosis requires great responsibility and complete examination of the patient. If the treatment regimen is chosen incorrectly, then remission of the disease will not occur, the patient will not experience improvement or decrease in clinical manifestations diseases. In cases where the doctor chooses the right combination and regimen of chemotherapy drugs, it is possible to for several months achieve significant improvement in condition.
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For treatment to be successful, several medications must be prescribed. The first thing we encountered in 1946, when we began to treat tuberculosis with streptomycin, was relapses due to the development of drug resistance in the pathogen. With the introduction of multiple drugs, especially isoniazid in combination with rifampicin, the risk of drug resistance has decreased significantly. Despite the fact that the bulk of rapidly reproducing mycobacteria die quite quickly after the start of treatment, it must be long and continuous, since there are still persistent, slowly reproducing or latent mycobacteria, the destruction of which requires time.
Several large clinical trials carried out with the support of the Ministry of Health and social services USA and British Council medical research, showed that treatment of pulmonary tuberculosis can be continued for 6 months if a combination of three drugs is used for the first 2 months and only isoniazid and rifampicin for another 4 months. At the first stage, drugs should be prescribed daily, later - twice a week. In these trials, cure was achieved in more than 95% of cases, and the disease-free period lasted at least a year. Based on the test results, a standard treatment regimen was approved: for 2 months - isoniazid, rifampicin and pyrazinamide daily, for the next 4 months - isoniazid and rifampicin daily or 2-3 times a week.
If pyrazinamide is intolerant, isoniazid is prescribed in combination with rifampicin for 9 months; if there is intolerance to isoniazid or rifampicin or if the pathogen is resistant to any of these drugs, two more are additionally prescribed, usually ethambutol and streptomycin, and treatment is continued for 12-18 months. The same regimens can be used for extrapulmonary tuberculosis. It is believed that treatment of HIV-infected people should last at least 9 months, although it is possible that the usual course will be sufficient.
The choice of drugs is influenced by the sensitivity of the pathogen. In 1997 in the United States, 7.8% of Mycobacterium tuberculosis strains were resistant to isoniazid, and 1.4% of strains were resistant to both isoniazid and rifampicin. These rates were significantly higher in California, Florida, New Jersey and New York City; In 35 states, the proportion of isoniazid-resistant strains was at least 4%. In areas where the prevalence of isoniazid-resistant strains exceeds 4% or is unknown, a fourth drug, ethambutol or streptomycin, is additionally prescribed at the first stage. After assessing the sensitivity of the pathogen, the scheme is adjusted: if sensitivity is preserved, they return to the usual scheme; if the pathogen is resistant to isoniazid or rifampicin, the course of treatment is extended to 18 months.
Repeated treatment in the absence of effect and treatment of multidrug-resistant tuberculosis are not within the competence of the doctor general practice. Resistance of Mycobacterium tuberculosis to both isoniazid and rifampicin complicates treatment: it is necessary to prescribe less effective and more toxic drugs and increase the duration of the course.
To achieve the desired effect and avoid adverse events, it is necessary to monitor the patient during the treatment process. He must visit the doctor at least once a month to assess the manifestations of the disease and complications of treatment.
For pulmonary tuberculosis, sputum examination is carried out: first monthly for 3 months or until a negative result is obtained, then at the end of treatment and after another 3-6 months. Radiography chest desirable, but not required. Much more important indicators success in treatment - patient’s condition and data bacteriological research. The X-ray picture should, of course, improve during treatment, but such pronounced changes as, for example, closure of cavities are not at all necessary. Before starting treatment, it is recommended to general analysis blood, determine the level of BUN, the activity of liver enzymes, the level uric acid(before prescribing pyrazinamide), and also examine vision (before prescribing ethambutol). Since all three major drugs are hepatotoxic, liver enzyme activity should be measured monthly. With a moderate increase in these indicators, treatment can be continued, since in the future they often return to normal, but it is necessary to carefully monitor the patient.
The main reason for the ineffectiveness of treatment is non-compliance with doctor's instructions. It is useful to talk with the patient, explain to him the nature of the disease and the need to continue treatment long after the condition has improved.
Another effective method- a system of supervised outpatient therapy: the most conscientious family member or person caring for the patient gives him pills before each appointment and makes sure that the patient takes them. The method is most convenient when the drugs are taken 3 times a week, and is suitable for any patient who can be expected to take treatment lightly. These, apparently, include drug addicts and alcoholics. Socioeconomic status or level of education does not predict how conscientious a patient will be about treatment. Given the danger of a resurgence of tuberculosis, where less than 90% of patients comply with doctor's orders (that is, everywhere), it is recommended that all treatment be carried out under direct observation.
Compulsory treatment is rarely used. Anything that simplifies treatment (for example, reducing medication to two or three times a week) will help promote compliance. Using combination drugs(rifampicin / isoniazid or rifampicin / isoniazid / pyrazinamide) the patient, willy-nilly, has to take everything that is prescribed to him. Very often, to prevent such a rare side effect isoniazid, as neuropathy, pyridoxine is additionally prescribed. In this case, the patient can start taking only the vitamin; therefore, the administration of pyridoxine may bring harm rather than benefit. The best tactic is to keep treatment simple.
Many people are interested in whether tuberculosis can be cured or not. Modern medicine has made a breakthrough in methods and methods for curing this disease. Today they give positive prognoses to patients. The most important thing is to apply for timely medical care. What methods are used in treatment? Can you trust folk recipes? We will try to find answers to these questions in the article.
This terrible word is tuberculosis
When colliding with terrible disease Patients have a question: “Is tuberculosis curable or not?” If in the 90s up to 80% of those sick died from the disease, in our time the percentage has decreased significantly. Modern medications, new treatment methods. Doctors talk about enormous progress in resolving this issue.
Don't forget that positive result largely depends on how timely the patient sought consultation.
Studying the symptoms
Every person should know the symptoms of the disease:
- Elevated temperature that lasts for a long time.
- General malaise: drowsiness, weakness, depression.
- Night sweats.
- Continuous cough.
- Enlarged lymph nodes.
- Chest pain.
It is not necessary that all the symptoms “come out” at once. The first thing that should alert you is a cough that does not go away after taking the appropriate syrups and mixtures. In this case, you must consult a doctor and undergo a special examination (fluorography or x-ray). If the diagnosis is confirmed, only a doctor can answer the question of how to treat tuberculosis. It all depends on individual characteristics body.
Can tuberculosis be cured?
At the first suspicion of tuberculosis, you should immediately consult a doctor. The result of treatment depends on how quickly this is done. Unfortunately, many people put off visiting medical Center until the last minute, thereby only aggravating the situation. Doctors are often asked the question: “Is tuberculosis curable?” Experts give a positive answer to this.
First of all, it is necessary to confirm the diagnosis. This can be done using a special device - a fluorograph. Treatment in the future will depend on the form of tuberculosis. In cases with open outbreaks, it is planned to carry out special measures in tuberculosis dispensaries.
When answering the question about how long tuberculosis is treated, doctors do not give exact dates. This process is quite lengthy, on average it takes from 12 to 18 months. Treatment is carried out comprehensively. In addition to drugs that have an anti-tuberculosis effect, it is necessary to take drugs that increase the body’s immune qualities. Doctors prescribe appropriate dosages: they start with the minimum, eventually reaching the maximum amount. It is important that treatment is carried out under the constant supervision of a pulmonologist and physiotherapist.
Open form - is there a chance of recovery?
“How long does it take to treat tuberculosis?” - perhaps this is one of the most popular questions from patients. It all depends on the form of the disease. If it is open, the patient will have to spend more time in the hospital to prevent infection of people nearby. First of all, the doctor is faced with the task of converting the disease into a closed form. In this case, the outbreaks become safe for others. This can be done with the help of special drugs. They are quite expensive, but you can’t do without their help.
Answering the question whether open tuberculosis can be treated, experts give a positive prognosis. The only thing is that it will take more time and effort. Do not forget about drugs that are responsible for increasing the body’s immunity. During this period, it is important that all resources are used and the organs work at full capacity.
Features of treatment in children
The child can also become infected with tuberculosis. This happens if the parents did not immunize on time. In order to protect the baby, he is given BCG vaccination. Then vaccination takes place according to a specific schedule approved by WHO.
Many parents are interested in: “Is there treatment for children?” The recovery process is complicated by the fact that most drugs are prohibited for children. They can cause serious disorders in the body, reduce immunity, change hormonal balance and much more. In this case, doctors suggest following diagrams treatment:
- Use medications that remove foci of tuberculosis.
- Use immunostimulating tablets.
- Don’t forget about additional techniques: breathing exercises, physiotherapy, acupuncture.
In cases where the above methods do not help, specialists have to resort to drastic measures - surgical intervention. The lung is cleaned, lesions are treated, excess mucus and accumulated fluid are removed. After this, in 80% of cases, children have a chance of recovery.
Tuberculosis in old age. Is it treatable?
The situation is different for people over 55 years of age. It's all about the changes that occur in the body. In this case, doctors need to make every effort to cure the patient. not enough. The general condition of the patient is actively maintained. Vitamins and drugs that enhance immunity are prescribed.
As a rule, doctors do not give comforting prognoses. It is not possible to completely get rid of the disease. Specialists can only improve the patient’s general condition and remove acute form tuberculosis. In any case, older people are under the constant supervision of a pulmonologist.
Physiotherapy is a method that brings benefits
Many doctors, in addition to drug treatment, offer physical therapy. She may have different shapes: ultrasound, infrared radiation, laser, application magnetic field and much more. It all depends on the severity of the disease. Basic goals this method are as follows:
Death of microorganisms and bacteria that cause tuberculosis.
Removal of phlegm and fluid from the bronchi and lungs.
Termination and relief of inflammatory processes.
Feeding the body with pure oxygen.
Restoration of lung tissue.
It is impossible to cure tuberculosis with physiotherapy alone. This method is only an addition to the main treatment. It helps speed up the healing process, improving the general condition of the patient.
Is there any point in breathing exercises?
Many experts have a positive attitude towards breathing exercises. They need to be performed daily, while monitoring general condition sick. Gymnastics performs the following functions:
- Strengthens muscles, lungs, bronchi.
- Helps improve gas exchange. Oxygen reaches the lungs faster.
- Restores correct breathing rhythm.
There are quite a lot of exercises; only a doctor has the right to decide which of them to use in a particular case. In this case, constant monitoring of the patient’s condition is necessary. It is advisable that the first procedures take place in the presence of a doctor or visiting nurse.
Many people ask: “Is tuberculosis curable or not with the help of breathing exercises?. Doctors assure that without intensive drugs that will destroy bacteria, it will not be possible to cope with the disease. Additional techniques can and should be used, but they are not fundamental in the treatment process.
Traditional treatment
Unfortunately, tuberculosis is a fairly common disease. To deal with it, many use folk recipes. Medvedka helps to overcome the disease. The fact is that leukocytes are present in sufficient quantities in the insect’s body. They are able to break down and remove it with sputum. It is necessary to dry the mole cricket, grind it into a pulp and take it for at least 3 days. After this, there is copious discharge of sputum and a severe cough.
Regular badger fat will help boost your immunity. It can be purchased at a pharmacy. It is available in the form of tablets or capsules. To improve the effect, you need to eat a spoonful of honey at the same time.
Garlic and horseradish can help in the fight against the disease. They will not only strengthen the immune system, but will also promote the removal of sputum. Garlic can be consumed up to 5 heads per day. And the horseradish root is grated, placed in a three-liter jar, filled with whey and placed in a warm place for 4 days. After the expiration date, drink half a glass of the product per day.
Patients often ask the question: “Is tuberculosis curable or not? traditional methods?. Doctors are sure that you cannot self-medicate, this will only aggravate the situation and precious time will be lost. At the first signs of illness, you need to contact a specialist and have fluorography done.
When asked whether tuberculosis is curable or not, doctors give a positive answer. Thanks to modern medicine, strong drugs, new developed techniques can cope with the disease. To do this, you just need to promptly seek advice from specialists and follow all their instructions and recommendations.
