Drug treatment for tuberculosis. Pulmonary tuberculosis - signs in the early stages, symptoms, forms, treatment in adults and prevention. treatment option with drugs for the category of patients with relapse

Tuberculosis treatment regimens should be understood as different 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 the conditions of 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. For the treatment of the disease, chemotherapy drugs are used, which differ in efficiency and safety.

To simplify the appointment of therapy and prevent the development of resistance of mycobacteria, special schemes. They are prescribed depending on the identified type of disease, the resistance of the pathogen and other indications.

4 TB treatment regimens

In all regimens of therapy, intensive phase and continuation of treatment. The first lasts from two months and is aimed at achieving remission. In this case, the most powerful means are usually used. The continuation phase is conducted with drugs that are selected based on how effective the active treatment was. Its purpose is primarily to consolidate the achieved state of remission and prevent exacerbation of tuberculosis.

1 chemotherapy system for primary patients

This therapy regimen is shown apply to patients:

with newly diagnosed tuberculosis and the presence of mycobacteria in sputum;
without isolation of the pathogen, with such forms of the disease as disseminated tuberculosis and pleurisy.

The intensive phase lasts two to three months until the sensitivity and resistance of mycobacteria is determined using laboratory methods.

It is based on the use of 5 drugs: Rifampicin, Isoniazid, Streptomycin, Pyrazinamide and Ethambutol.

Important. TB kills every year 3 million human. It's more than from AIDS, malaria, diarrhea and all tropical diseases combined.

During the intensive phase, the patient should ingest at least 60 doses chemotherapy drugs in an established combination. In cases where the patient misses taking the medicine for one reason or another, the deadline is shifted by one day. In any case, he must take all the prescribed doses of drugs.

The transition to the continuation phase is considered to be the cessation of the isolation 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 a after 60 days treatment, the sensitivity of the pathogen to the drugs of the first line of therapy remains, then the medication is continued within 4 months. The patient at this time 120 doses of Isoniazid and Rifampicin. The use of drugs can be daily or intermittent, that is, once every two days. As an alternative, there is combination of ethambutol with isoniazid, which should be taken within six months.

Photo 1. In the photo, drugs for tuberculosis for intravenous and oral administration and a disposable syringe.

Treatment option 2 with drugs in the category of patients with relapse

Allocate two schemes such anti-tuberculosis therapy:

2a- shown to patients with relapse diseases and patients who received inadequate treatment over a month. for example, it is used in people who have been treated with the wrong combination of chemotherapy drugs or have received insufficient amounts of drugs. In this case, the likelihood of drug resistance should be low;
2b- is used to treat patients with a high probability of developing drug resistance MBT. 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 scheme

During the intensive phase reception is shown:

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.

The patient during the entire intensive phase receives 90 doses four essential anti-tuberculosis drugs and 60 doses Streptomycin. If, after three months of therapy, the sensitivity of the pathogen persists, then further use is prescribed. 150 doses Isoniazid, Rifampicin, and Ethambutol. Can use them daily or in three times in 7 days.

If bacterial excretion continues at the end of the intensive phase, determined by sputum smear microscopy, or bacterial resistance to drugs is determined, it is necessary to change the chemotherapy regimen. In this case, the patient continues to take drugs, the effectiveness of which is preserved, but additionally, reserve funds are prescribed. The duration of the course is increased by 60-90 days.

In most cases, this treatment regimen is carried out within nine months. If at the same time multiple drug resistance of the pathogen is determined, the patient is transferred to the IV variant of chemotherapy.

2b scheme

In this case, in the intensive phase of treatment, the therapy regimen is supplemented with Kanamycin and Fluoroquinolone.

The continuation phase is determined by the results of the study of resistance of mycobacteria.

If multiple MBT resistance to agents such as Rifampicin or Isoniazid, the transfer to the fourth regimen of chemotherapy is shown.

3 way active therapy

A third chemotherapy regimen is used to treat first identified pulmonary tuberculosis without isolation of mycobacteria. For its appointment, the lesion of lung tissue in a patient should not exceed an area equal to two segments.

The intense phase usually lasts two months. At this time, first-line 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 drugs. In such cases, continuation of therapy is indicated until this information can be obtained.

The continuation phase of treatment occurs when there is a pronounced positive dynamics of clinical and radiological manifestations. In such cases, the use Isoniazid and Rifampicin in the following modes:

120 doses for four months daily;
The same number of drugs in intermittent mode - 3 times a week.

Also in the continuation phase of treatment, you can use Ethambutol and Isoniazid within half a year. The total duration of chemotherapy during the third regimen of therapy is 6-8 months.

Fourth order of treatment for tuberculosis with resistant microbacteria

This chemotherapy is indicated for patients who excrete a lot drug resistant mycobacteria. Therefore, before the start of taking drugs in a patient, the sensitivity of the MBT should be determined. For this, it is better to use express methods, for example, BACTEC system.

Photo 2. Doctor's appointment, in the background is a picture of the lungs. There is a sterile mask on the doctor's face.

According to the results of data on drug sensitivity of Mycobacterium tuberculosis, an individual chemotherapy regimen is selected.

Reference. Treatment is carried out only in a specialized tuberculosis hospital. This is due to the need carefully control both the results of microbiological studies and the effectiveness of therapy.

The drugs indicated for the treatment of patients with MBT drug resistance 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 is used, consisting of at least five drugs. The main drugs can be added to the 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 the appearance of positive clinical and radiological dynamics, as well as obtaining at least two negative results in bacteriological examination of sputum.

Together with the use chemotherapy funds can be used surgical methods, for example, the imposition of an artificial pneumothorax. This allows you to significantly accelerate the process of onset of remission of the disease.

The continuation phase occurs when the patient has stabilization of the course 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 consisting of at least three anti-tuberculosis drugs, including the main ones, to which sensitivity is preserved. Duration of medication - more than 12 months.

Useful video

Do I need to undergo fluorography annually? Every year, 9 million cases of tuberculosis infection and 3 million deaths are registered in the world. The video shows how this disease is treated in the scientific and practical center.

Conclusion

The choice of a TB chemotherapy regimen requires a lot of responsibility and complete examination of the patient. If the treatment regimen is chosen incorrectly, then the remission of the disease will not occur, the patient will not experience an improvement in the condition and a decrease in the clinical manifestations of the disease. In cases where the doctor chooses the right combination and regimen of chemotherapy, it is possible to for several months achieve significant improvement.

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According to statistics, tuberculosis is one of the ten leading causes of death worldwide.. Thanks to the WHO End TB Strategy, the incidence rate is gradually decreasing globally (by about two percent per year). And yet, tuberculosis continues to be the most complex and significant social and medical problem.

The death rate from tuberculosis is about 1.7 million people a year.

Before the discovery of antibiotics, tuberculosis was considered an absolutely incurable disease. At the moment, many highly effective treatment regimens for this disease have been developed, however, multidrug-resistant forms of tuberculosis present significant difficulties for treatment.

Due to the rapid growth of resistance of Mycobacterium tuberculosis to antibacterial drugs, all treatment should be prescribed exclusively by a phthisiatrician, after a complete examination and obtaining cultures for the sensitivity of the pathogen to drugs. It is strictly forbidden to independently adjust the treatment, dosages, regimens and frequency of administration, as well as stop treatment ahead of time.

Treatment of tuberculosis at home with folk remedies is unacceptable. Herbs, infusions, a method popular on the Internet - dried Medvedka from pulmonary tuberculosis are not effective and cannot replace a full-fledged complex anti-tuberculosis therapy.

It must be understood that folk remedies for pulmonary tuberculosis in adults and children can only be used as an addition to the treatment prescribed by a phthisiatrician for a general strengthening purpose. All folk recipes and herbs for tuberculosis can be used after consultation with a phthisiatrician.

Tuberculosis is a curable disease, but a number of factors must be taken into account. Mycobacterium tuberculosis are widespread bacteria and are characterized by a high level of survivability and the ability to adapt to various environmental factors. In some cases, Koch's wand can go from active to dormant, while becoming immune to the effects of antibiotics.

Also, the bacterium is able to quickly develop resistance to the drugs used.

In particular, a high risk of developing multidrug-resistant tuberculosis (insensitive to most or all known anti-TB drugs) is observed in patients with HIV and in those who miss timely intake of prescribed drugs, stop treatment prematurely, etc.

It must be understood that for a complete cure for tuberculosis, a long period of time and regular medication are needed. Early withdrawal of therapy (with stabilization of the patient's well-being) can cause reactivation of the infection and the development of resistance to the drugs used.

At the same time, if a patient has open tuberculosis, he can infect others with a multidrug-resistant disease (first of all, relatives of the patient are at risk).

The medicine for tuberculosis is selected by a phthisiatrician in a hospital. As a rule, complex treatment is prescribed, including four to five agents. The duration of treatment and the selected schemes are strictly individual.

How many live with tuberculosis in an open form

With timely admission to the hospital, good sensitivity of mycobacteria and the absence of concomitant pathologies that aggravate the severity of the patient's condition, the disease is curable.

Treatment of tuberculosis in a hospital

The open form of tuberculosis is highly contagious. In this regard, all treatment takes place in the conditions of an anti-tuberculosis dispensary. The duration of the transfer of an open form to a closed form is individual and can range from two to four or more months.

The duration of further treatment is also individual.

Patients with closed forms of tuberculosis can be treated at home. In the future, patients are prescribed supportive, as well as sanatorium-and-spa treatment.

Disability in pulmonary tuberculosis

In most cases, the issue of registration of disability for tuberculosis is considered if the treatment takes more than ten months. The decision to assign a group is made on the basis of the results of a medical and social examination. The disability group assigned to the patient depends on the severity of the disease and the degree of impairment of body functions.

The main indications for referral to the ITU (medical and social examination) are:

duration of treatment more than 10-12 months;
the appearance of completely or partially irreversible violations of body functions, leading to the fact that the patient needs a change in working conditions;
severe course of the disease, accompanied by disability and / or the need for outside help (loss of ability to self-service);
the need to conduct another re-examination, change the previously established cause of disability, change the previously assigned group, receive recommendations regarding further employment.

According to the results of the medical commission, the patient is assigned the status of temporary disability or a disability group corresponding to the severity of his condition. Assignment of social and labor pensions to patients with tuberculosis is carried out in accordance with the received disability group.

As benefits, patients are entitled to:

registration of a sick leave for a period of nine to twelve months, with guaranteed job retention;
registration of social insurance benefits;
provision of free medicines from a special list of anti-tuberculosis drugs;
free spa treatment.

Where can I work after tuberculosis

Admission to work after tuberculosis is issued by the VKK (Medical Advisory Commission). Permission to continue studies or return to work is issued on the condition that:

complete completion of the course of anti-tuberculosis treatment;
lack of symptoms of the disease;
laboratory-confirmed absence of bacterial excretion (triple analysis and intervals of two to three months);
no signs of reactivation of pathological processes.

Patients after tuberculosis are strictly forbidden to work in the following areas:

healthcare (hospitals, pharmacies, laboratories, etc.);
Catering;
education and in preschool children's institutions (kindergartens, schools, institutes, etc.);
trade.

Also, patients after tuberculosis are contraindicated in hard physical work, work involving contact with dust, chemicals, coal dust, hot air (work in workshops), night shifts, etc.

Patients after tuberculosis are allowed to work as accountants, statisticians, programmers, economists, work at home or in workshops at a tuberculosis dispensary, repair shops, etc.

Treatment of pulmonary tuberculosis in adults

To achieve maximum effectiveness, therapy should be timely, combined, strictly controlled and regular (skipping medication is unacceptable), long-term and sufficiently intensive, phased, and also prescribed taking into account the sensitivity of mycobacteria to the antibacterial drugs used.

Anti-tuberculosis drugs (TBDs) are usually divided into three groups:

class A medicines (the most effective drugs) - drugs of isoniazid (tuberculosis tablets isoniazid are among the most effective and commonly prescribed drugs) and rifampicin;
class B drugs (medium effective drugs) - drugs of streptomycin, ethambutol, pyrazinamide, ethionamide, kanamycin, cycloserine, viomycin;
class C drugs (low-potency drugs).

The main drugs used in classical regimens include isoniazid (H), rifampicin (R), ethambutol (E), streptomycin (S), pyrazinamide (Z).

Second-line reserve drugs include thioacetozone (T), prothionamide (Pt), ethionamide (Et), kanamycin (K), amikacin (A), capreomycin (Cap), cycloserine (Cs), rifabutin (Rb), PASK (PAS), fluoroquinolones (Fq), amikacin (Am), etc.

The classic scheme for tuberculosis is the appointment of isoniazid, rifampicin, pyrazinamide, ethambutamol and streptomycin (H, R, Z, E, S). In this case, streptomycin is used for a course of no more than two months. Combinations of RHZE or RHZ may also be given. For maintenance courses, a combination of rifampicin and isoniazid is prescribed.

For convenience, combined means are often used:

Rifater (isoniazid, rifampicin and pyrazinamide);
rifampicin, isoniazid and ethambutamol and others.

Treatment of tuberculosis in children

Treatment of tuberculosis in children is carried out according to similar schemes (usually HRZE). Dosages are calculated depending on the weight of the patient.

In addition to tuberculosis chemotherapy, for the treatment of children and adults, collapse therapy (creation of artificial pneumothorax and pneumoperitoneum), thoracoplasty, therapeutic fibrobronchoscopy, physiotherapy exercises, breathing exercises can be used (for tuberculosis, breathing exercises according to Bolotov, etc. can be used).

Surgery for pulmonary tuberculosis

Surgery is used as an adjunct to chemotherapy. For the treatment of tuberculosis can be used:

thoracoplasty (removal of ribs);
pneumolysis (creation of an artificial cavity with a gas bubble, but is rarely used today);
surgical interventions on the peripheral nerves, in order to change the blood circulation and lymph circulation in the lungs;
resection of the affected lungs;
decortication and pleurectomy;
cavernotomy;
surgery to stop pulmonary bleeding.

Treatment of tuberculosis after surgery is continued according to previously prescribed chemotherapy regimens.

Treatment of tuberculosis with folk remedies - the most effective schemes

Patients often ask the phthisiatrician whether it is possible to put mustard plasters for tuberculosis, use herbs and can they replace drug treatment? No. All treatment should be complex, long-term and individual. Tuberculosis cannot be cured without antibiotics.

Despite the fact that long-term antibiotic therapy is fraught with various complications, in this case, this is a justified risk. Early discontinuation of drugs can lead to the development of a completely drug-resistant form of the disease.

No folk remedies can cure tuberculosis. The use of honey with aloe, fish, badger, bear fats, herbal tinctures, etc. are not pathogenetic therapy for tuberculosis. All these funds can only be considered as a general strengthening addition to the antibiotic treatment regimen prescribed by the doctor.

Consequences of tuberculosis

The consequences of the disease are divided into complications of tuberculosis during the active phase of the disease and the consequences of long-term treatment with anti-tuberculosis drugs, as well as surgery (thoracoplasty for tuberculosis is used in severe cases of the disease, as an addition to chemotherapy).

Complications of pulmonary tuberculosis can be:

development of cardiopulmonary insufficiency;
the appearance of hemoptysis or pulmonary bleeding;
development of spontaneous pneumothorax;
the formation of tuberculous pleurisy, pleural empyema, atelectasis, etc.;
attachment of extrapulmonary forms of tuberculosis (tuberculous meningitis, lesions of mesenteric lymph nodes, etc.)
disability as a result of residual changes in the lungs (fibrous, fibro-focal, bullous-dystrophic, cirrhotic, pleuropneumosclerotic, etc.), as well as due to impaired respiratory function after surgical treatment (removal of part of the lung, etc.);
development of secondary tuberculosis, etc.

It should also be noted that since pathogenetic therapy for tuberculosis can

take more than a year (the duration of treatment depends on the severity of the disease and the sensitivity of Mycobacterium tuberculosis to antibiotics), patients often experience various side effects from long-term and intensive antimicrobial therapy:

allergic reactions;
violations of the functions of the liver and kidneys;
jaundice;
disorders of the gastrointestinal tract;
heart rhythm disturbances;
accession of fungal infections;
problems with conceiving and bearing a child;
pain in muscles and joints;
headaches, dizziness;
noise in ears;
severe dysbacteriosis;
weakness;
sustained rise in temperature;
anxiety, insomnia, depressive disorders;
changes in the hemogram (leukocytopenia, neutropenia, thrombocytopenia);
blood clotting disorder, etc.

To reduce the risk of side effects, all antibiotics for tuberculosis should be taken under the control of laboratory parameters of liver function, kidney function, blood clotting, etc.

Tuberculosis and HIV infection

HIV infection and tuberculosis have a mutually reinforcing effect on each other. It should be noted that it was the HIV epidemic at the end of the last century that became the main reason for the rapid increase in the incidence of tuberculosis throughout the world.

HIV remains the leading risk factor for developing tuberculosis in adults and children. According to statistics, tuberculosis is the most common infection leading to the death of patients with HIV.

In this case, there are two options for combining these infections:

accession of tuberculosis in patients with HIV or acquired immunodeficiency syndrome (AIDS);
accession of HIV or AIDS in patients with active tuberculosis or exacerbation of the process after the end of treatment.

The high incidence of tuberculosis in patients with HIV allows us to conclude that when the immune system is affected by the human immunodeficiency virus, a latent post-tuberculosis infection, previously present in the patient, but restrained by its own immunity, is reactivated.

Due to damage to the immune system of HIV, as well as impaired differentiation of macrophage cells and the formation of specific granulation tissues, in patients with tuberculosis in the late stages of HIV, specific tuberculous granulomas may not form.

The severity of tuberculosis directly depends on the stage of HIV. The less CD4 cells in the patient's blood, the faster and more severe the damage to the lungs.

A feature of the development of tuberculosis in patients with AIDS can be considered its malignant and fulminant development, the rapid progression of lung decay in tuberculosis, the tendency to severe necrotic reactions, as well as the frequent addition of extrapulmonary forms of tuberculosis (tuberculous meningitis, lesions of mesenteric lymph nodes, etc.) and the ineffectiveness or ineffectiveness of prescribed anti-tuberculosis treatment.

How many live with HIV and tuberculosis together?

With the addition of tuberculosis sensitive to antibiotic therapy in the early stages of HIV, subject to adequate antiretroviral and anti-tuberculosis treatment, patients can live 10, 20 or more years (terms are individual).

For multidrug-resistant forms of tuberculosis or the addition of tuberculosis already in the late stages of AIDS (tuberculosis in the decay stage in such patients is characterized by a fulminant malignant course), as well as if the prescribed drug regimens are not followed, the prognosis is unfavorable (less than a year).

Article prepared
infectious disease doctor Chernenko A.L.

Modern methods of treatment of pulmonary tuberculosis
Alternative treatment for pulmonary tuberculosis

Tuberculosis is one of the social diseases of mankind. The disease has adapted to those antibiotics that previously turned the treatment of pulmonary tuberculosis into an effective process and gave a positive result, and now phthisiatricians have to look for new ways to combat the microorganisms that cause the disease. This disease continues to cover more people, but with the right approach to treatment, you can successfully defeat and prevent its manifestation.

In order to overcome the disease, we need the coordinated work of not only a general practitioner, but also a phthisiatrician, a specialized nurse and a great desire to recover the patient himself.

If uncontrolledly treated with drugs, this process will not lead to positive results, but will increase the risk of mortality, lead to frequent relapses and will contribute to the formation of drug resistance in the patient.

Treatment for pulmonary tuberculosis and doses of drugs should be determined by a specialist. Only he will be able to eliminate the clinical manifestations and laboratory signs of tuberculous inflammation and give an accurate answer to the question of how to treat tuberculosis. An experienced phthisiatrician with the help of complex therapy will prevent bacteriological secretions and will contribute to the onset of regression of the radiological manifestations of the disease. The patient will restore functionality and ability to work.

Therapy for the treatment of tuberculosis includes several types:

pharmacological - anti-tuberculosis drugs;
pathogenetic - with the treatment of concomitant diseases;

collapsological;
surgical.

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The progressive development of the disease and the rapid reproduction of microorganisms contribute to their instantaneous spread through the blood, lymph, and bronchi. The focus of specific inflammation itself is inhabited by several populations of Mycobacterium tuberculosis. They differ in the degree of localization and metabolic activity. If the process is very active, then the number of mycobacteria is greater than usual, and their metabolic activity increases. Given all of the above, the process of pharmacotherapy is divided into two periods:

initial, including intensive treatment (rapid suppression of microorganisms whose metabolic activity is quite high);
final (suppression of the remaining bacteria with low metabolic activity).

The second stage is very important in terms of preventing the reproduction of microorganisms that are still inside the cells.

Highly effective basic drugs for the treatment of tuberculosis include Isoniazid, Rifampicin, Pyrazinamide, Ethambutol, Streptomycin. There is a specific treatment regimen that a phthisiatrician will prescribe. Features of the dynamics of the disease, drug sensitivity of the pathogen, individual tolerance, concomitant diseases can affect the treatment regimen for each patient.

Kanamycin, Amikacin, Cycloserine, Prothionamide, Ethionamide are used as reserve drugs. These drugs can be treated for those patients who have resistance of mycobacteria to the main treatments for.

The initial stage of treatment is usually continued until the period of obtaining positive dynamics. Smears and cultures taken from the patient during this period must be negative. After the main one, maintenance treatment should be carried out for a year. At least 3 medicines to which Mycobacterium tuberculosis is susceptible should be continued during this period.

Pharmacological therapy is carried out on an outpatient basis, for a long time and requires a sick adult or child to be aware of the importance and danger of possible complications. Therefore, discipline and the irreproachable implementation of all the doctor's recommendations are above all!

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This type of fight against the disease includes the correction of functional disorders that can be caused by toxins from tuberculosis microbacteria. Pathogenetic treatment is the exact observance of the motor regimen (physiotherapy exercises), proper medical nutrition, detoxification, hormonal, immunomodulatory treatment, bed rest (in severe forms).

The main role is still occupied by medical nutrition. To correct a disturbed metabolism, you need to take proteins, fats, carbohydrates, calcium, phosphorus, salt and vitamins in certain proportions. The energy value of food should be 2880-3000 kcal per day during bed rest and 3500-4000 kcal per day during training. Every day, a tuberculosis patient should take 80-90 g of fat per day, half of which is of plant origin. Many experts recommend being treated with badger fat.

For complete detoxification, intravenous laser blood irradiation, plasmapheresis is used. Hormone therapy is prescribed for the following diseases:

infiltrative tuberculosis;
caseous pneumonia;
exudative pleurisy;
tuberculosis of the bronchi, trachea.

At the same time, Prednisolone 15-20 mg orally is prescribed once a day for 5-7 weeks.

During the period of continuation of treatment, reparative processes are stimulated, physiotherapy, tuberculin therapy, and vaccine therapy are prescribed.

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Surgical treatment for pulmonary tuberculosis and collapse therapy

Modern techniques suggest, in some cases, an artificial pneumothorax. With the help of a gas that is injected into the affected lungs of the patient, they are squeezed. The whole therapeutic effect of this procedure is that the elasticity of lung traction decreases. In this case, the decay cavities are completely reduced. Hemostasis and lymphostasis helps to reduce the process of absorption of toxins and dispersion of microbacteria that cause tuberculosis.

Applied with destructive tuberculosis, with pulmonary bleeding.

If tuberculomas, solitary cavities, polycavernous and cirrhotic lesions of the lungs have formed, then surgical treatment is used. Severe forms of impaired respiratory function, the rapid spread of tuberculosis bacteria throughout the body (blood circulation, kidneys, liver) require timely surgical intervention from doctors.

The effectiveness of treatment is determined by the dynamics of radiographic and clinical changes, according to laboratory tests, which are carried out on the 5th, 6th month of treatment. If the clinical picture is positive, then the number of tuberculosis microbacteria when examined with a microscope becomes negative. There comes a "phenomenon of falling". But there are also cases when, at the 6th month of treatment, these indicators change dramatically for the worse. This phenomenon is explained by the multiplication of drug-resistant strains. Then you need to change medications and carry out treatment to clarify the sensitivity of MBT.

Side effects of drugs have their effect on the liver. Therefore, in the first months of treatment, a liver test is performed to avoid drug-induced hepatitis.

Tuberculosis or consumption can creep up imperceptibly and unexpectedly. Gone are the days when this infectious disease affected only people leading an asocial lifestyle, malnourished, not taking care of their health. The danger of the disease is that the pathogen - by the age of 30 is in the body of every person. Meanwhile, a mycobacterium that once enters your body will wait for the moment to manifest itself. Such a situation can be prolonged stress, poor nutrition, lack of physical activity in the fresh air. The disease, starting with a slight cough and malaise, which you, of course, attribute to stress and a small cold against the background of fatigue and reduced immunity, can develop rapidly. Remember, TB is curable, but TB treatment takes a long time, up to a year and a half if diagnosed late. How successfully tuberculosis is treated, how it is treated in modern conditions with new schemes and according to new principles, is presented in this review.

Diagnosis of respiratory diseases is becoming the lot of doctors in multidisciplinary hospitals. A phthisiatrician must treat patients with tuberculosis. If you, as a person who is conscious of your health, go yourself 1-2 times a year to the clinic in order to receive medical advice, then you will most likely be offered to go. Also, fluorography is carried out as part of mandatory medical examinations and medical examinations.

Important! According to the results of fluorography, when patients apply to institutions of the general medical network at the place of residence, from 30 to 50% of cases of tuberculosis are detected in the early stages.

Thus, early detection of symptoms is the key to a speedy recovery and a guarantee of a favorable prognosis.

During illness, mycobacterium (the original infection) enters the body, forming the primary focus of inflammation. Strong immunity will not allow the focus of inflammation to grow, it will be isolated in the tissue with a dense capsule. A weakened body is an ideal environment for the spread of tuberculosis infection. The primary focus of inflammation with a decrease in the body's defenses is activated, the infection spreads through the blood into the tissues of the body. It is with the spread of infection throughout the body that weight loss is associated.

How does infection develop in the body

Having penetrated into the body with a stream of air during the airborne route of infection (this happens most often), Mycobacterium tuberculosis will remain in the body for a long time and wait for the right moment to manifest itself.

initial stage

Symptoms that indicate that a person has the initial stage of tuberculosis:

The body temperature rises slightly, a person cannot always independently assess his slightly elevated temperature. Usually, when the infection spreads, the temperature is 37-37.5 degrees Celsius, and more often rises in the evening.
The patient most often has increased sweating at night.
Sudden weight loss - up to 5-10 kilograms and above. The process of weight loss is associated with the poisoning of the body and its need to get rid of mycobacteria.
A person feels a loss of appetite, weakness, fatigue, reduced efficiency.

If you have three or more of the listed items, you must urgently contact the nearest medical facility and do a fluorography.

The spread of tuberculosis throughout the body

The causative agent not detected 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 a person to still consult a doctor - chest pains appear, rejection of mucus with blood from the lungs - hemoptysis. The lymph nodes are enlarged.

The lung tissue is gradually destroyed, which causes the separation of blood from the lungs. As a result of the destruction of the lung tissue, cavities are formed - caverns, which are filled with connective tissue, which 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, the symptoms of respiratory tuberculosis are respiratory diseases and respiratory failure. If the focus is outside the respiratory organs, then intoxication and fever will be observed as symptoms.

Chronic forms

Late detection of the disease often plays a role in the formation of the chronic form of the disease. In addition, properly selected treatment, the patient's social and living conditions, the presence of bad habits, and intolerance to certain drugs are of high importance. Even with timely prescribed correct treatment, the factor of complete cure largely depends on the resistance abilities of the organism. How much tuberculosis is treated in each 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, is treated well by means of modern medicine. The used arsenal of antibiotics is able to 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 Koch's sticks are not released into the external environment and the sputum test for VC is negative. With an open form, treatment is carried out in a hospital - a tuberculosis dispensary.

The disease is curable with an 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 medical and surgical. Pulmonary tuberculosis is treated at all stages of the development 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 stationary conditions in phthisiatric medical facilities. The most important component of the treatment of tuberculosis in children is careful monitoring during the conduct and the appointment of a more gentle regimen. Tuberculosis in children and adolescents is cured in an average of 2 months. Preferred in the treatment of pulmonary tuberculosis in children and adolescents are:

Simultaneous use of no more than two drugs in minimal dosages;
Implementation of body-strengthening procedures - exercise therapy, massage, physiotherapy aimed at the chest;
Strengthening the patient's immunity.

The period of recovery of the body after an infection in children is generally shorter than in adults. With the right diet and the presence of strengthening factors for the body, the child's body is fully 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 a hospital

Important! To cure tuberculosis completely, you must follow the doctor's instructions. Strictly follow the treatment regimen, observe the dosage and frequency of taking the drugs, since antibiotics only work when taken regularly.

The most effective way is the treatment of tuberculosis in a hospital. Now there are modern methods of treatment of this infectious disease. The main advantages of treating tuberculosis in a hospital include: isolation of the patient from possible sources of infection and deterioration of the situation, constant monitoring of the condition and adjustment, control over compliance with medications.

The treatment regimen for tuberculosis includes chemotherapy, surgical interventions, pathogenetic treatment and collapse therapy.

Chemotherapy

Chemotherapy remains the only option in order to be completely cured of tuberculosis in a hospital setting. Simultaneously with chemotherapy, drugs are prescribed that increase the effect on mycobacterial components.

The treatment regimen consists of the first (bacteriostatic and bactericidal) and second (sterilizing) stages. The tuberculosis medicine 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! In order to cure tuberculosis completely and not to lose, but to acquire the body's defenses, the correct treatment regimen is required, which is prescribed by a phthisiatrician. It should take into account the stage of tuberculosis, its localization, the duration of the process and the sensitivity of your particular pathogen to antibiotics.

How to treat tuberculosis, which treatment regimen to choose and how many days the treatment should continue, only the doctor decides. 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. Tuberculosis drugs that most effectively deal with infectious agents are (R), (Z), (S), and (E).

After 20–25 days, the patient stops excreting infectious pathogens in the sputum - he is no longer contagious to others.

Tuberculosis is cured by a combination of chemotherapy and phthisiology methods, with the organization of proper nutrition, healthy sleep and rest regimens.

Chemotherapy regimens for tuberculosis include phases when drugs are needed to treat tuberculosis, which lasts 2–3 months. This is followed by a period of stabilization. During this period, the patient continues to take the drugs rifampicin and isoniazid, up to 4-6 months. This measure allows you to exclude the return of symptoms of the disease and the development of complications.

Throughout the treatment, total control over the patient's health is carried out with the help of and. Antibiotics for pulmonary tuberculosis may cease to help, despite the efforts of phthisiatricians, 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, introduced new concepts of ACCESS, SURVEILLANCE and RESERVE.

Pathogenetic therapy

In order to cure tuberculosis completely and not to lose, but to acquire the body's defenses, the correct treatment regimen is required, which is prescribed by a phthisiatrician. It should take into account the stage of tuberculosis, its localization, the duration of the process and the sensitivity of your particular pathogen to antibiotics.

To restore the resources of the body, weakened by prolonged exposure to antibiotics and tuberculosis infection, pathogenetic spectrum drugs are prescribed. In the process of treatment, the processes of regeneration of tissues of the respiratory organs are affected. The exclusion of pathogenetic treatment and the limitation of chemotherapy methods can lead to an imperfect type of healing of affected tissues.

Pathogenetic drugs

The pathogenetic drugs used in the complex treatment of tuberculosis include:

Anti-inflammatory;
non-steroidal drugs;
Steroid drugs;
Other tuberculosis medicines with anti-inflammatory activity.

It treats patients with a set of methods aimed at increasing the body's immune defenses. This includes the appointment of a complex of immunomodulatory drugs that affect T-lymphocytes.

Alternative Treatments

Next, we will try to answer the question of whether the infection, the so-called, is being treated or not. People suffering from an infectious disease for many years, when it periodically makes itself felt, wonder whether it is possible to cure tuberculosis completely. Practice shows that the disease is curable with 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 appointment of a phthisiatrician, however, they remain a reliable help in matters of additional symptomatic treatment of pulmonary tuberculosis and increased immunity.

It is necessary to observe the daily routine - walk in the fresh air, drink boiled or sterilized milk and grape juice. For expectoration of sputum, it is good to use an infusion of marshmallow root, a decoction of coltsfoot leaves. Pour a tablespoon of dry raw materials with 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 materials is infused in a glass of boiling water for an hour, use 2 tablespoons 3 times a day before meals), a decoction of pine buds (pour 1 teaspoon of buds with a glass of boiling water and hold in a water bath for 15 minutes, insist for 1 -1.5 hours).

With tuberculosis, fish oil is also prescribed 3 times a day before meals, a teaspoonful. It is useful to use white cabbage.

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 disease recurrence

Doctors recommend that people who have been ill and cured, as well as when the process is chronic, spend time in the fresh air, it is advisable to breathe sea air. No wonder Anton Pavlovich Chekhov, suffering from consumption, moved from Taganrog to Yalta to the sea to improve his health. recommended as a preventative measure against recurrence of the disease. For example, in the Crimea there are unique natural conditions of 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. Do not forget that proper balanced nutrition also cures tuberculosis patients, as well as fresh air.

High humidity, antisocial lifestyle, direct infection from the patient, insufficient or unbalanced nutrition - all this can lead to the development of tuberculosis. These are far from all the conditions that contribute to the disease, because any disease can progress in an organism weakened by stress. If a decade ago tuberculosis was considered the plague of the 20th century, today there are many effective methods of treatment and prevention.

Drug treatment of tuberculosis

Doctors recommend that the treatment of this disease be carried out in two stages: intensive and prologed. The first phase involves the cessation of bacterial excretion and lasts an average of two months. The purpose of this phase is to stop the development of tuberculosis and eliminate the danger of the patient to others. Necessarily such treatment should be carried out under the careful supervision of a pulmonologist in a hospital. For the second phase, there is no need to be constantly in the hospital. Outpatient treatment is selected for each patient individually and the doctor's visit schedule is calculated.

Treatment according to the three-component scheme

It was the very first treatment regimen used for a long time. Today it is called classical, although its use now practically does not bring the desired results. The main components of the first line are as follows:

PASK (para-aminosalicylic acid);
Streptomycin.

Treatment according to the four-component scheme

Due to the rapid adaptation of bacteria and their increasing resistance to chemicals, it is necessary to develop ever newer and stronger drugs. The result of many years of work was the scheme of their four components, among which are the following:

Ethionamide or pyrazinamide;
ftivazid or isoniazid;
Kanamycin or streptomycin;
Rifabutin or rifampicin.

The developer of this scheme is the Dutch scientist Karel Stiblo. Since 1980, this regimen has been adopted for the treatment of tuberculosis in 120 countries. The drugs used are called first-line drugs.

Treatment according to the five-component scheme

Modern medical centers prefer to use an even more powerful regimen than a three- or four-component regimen for treatment, adding a fifth - ciprofoclacin or another fluoroquinolone derivative. Preparations above the first generation are used in the fight against drug-resistant strains.

The use of drugs should be done daily without gaps for as long as 20 months. Other supporting, enhancing the effect or suppressing side effects of the drug are also added. This is a rather expensive and complicated treatment. In the case when the bacteria become resistant to the drugs used, the doctor may prescribe capreomycin, cycloserine and others. These drugs are from the reserve second line due to the toxic effects on the human body.

On December 28, 2012, bedaquiline, the newest drug for the treatment of drug-resistant forms of tuberculosis, was registered in the United States.

Treatment according to new BPaL and BPaMZ schemes

In 2017, TB Alliance announced the successful completion of testing of two more schemes.

The BPaL regimen is based on linezolid, pretomanid (PA-824), and bedaquiline. For 40 test participants, out of 69 of all respondents, the results were marked as successful.

The composition of BPaMZ includes the following drugs: pyrazinamide, moxifloxacin, pretomanid and bedaquiline. 240 patients took part in the trials.

Among the scientists of the post-Soviet space, namely representatives of the Russian Federation and Ukraine, criticism was received towards new overseas developments. Our physicians are confident that the presence of a network of dispensaries for inpatient hospitalization of patients with tuberculosis is much more effective than chemical novelties.

Concomitant Therapy

Due to the toxic effect of anti-tuberculosis drugs on humans, it is necessary to replenish the strength and support the immune system of patients. For these purposes, immunomodulatory drugs and detoxification formulations are used.

The first group supports the immune system, which is exposed to aggressive effects from first-line drugs and above. Detoxification is performed during a break or after taking the main medications, helping to eliminate unwanted symptoms.

Alternative Therapies

Medical methods of eliminating tuberculosis are the basis of its treatment, which should be strengthened and supported by other non-scientific methods. Fresh clean air, namely sea or forest air, has a very positive effect. Moreover, walks in the forest should take place in a pine forest. If marine therapy is useful only for patients with a mild form of the disease, then phytoncides from pine essential oil are indicated for all types of disease.

It is difficult to find such pine oases in a modern city, so pine pollen can be a good substitute. During the flowering period, trees release it on their microstrobiles - male flowers. The collection of pollen must be carried out in a certain period so that it does not crumble yet, but is already ripe. This is mainly mid-May, although there are different types of trees and different climatic features that contribute to the shift of this period. To get about 2 liters of pollen, you need to collect a whole 10-liter bucket of pine flowers.

This natural medicine contains many trace elements: calcium, magnesium, phosphorus and choline. Indoors, you need to pour pollen on a spread oilcloth or newspaper and wait a few days for it to free itself from the flowers. The use of pine pollen for the purpose of treatment can be different, for example, a mixture with honey, an alcoholic tincture as a tea, or as a separate product without additives in its pure form.

Folk ways and means in the fight against tuberculosis

The most famous folk remedies are:

Medvedka;
Garlic;
Aloe;
Vinegar;
Animal fat;
Wax moth.

You need to prepare a honey mixture from a dried bear in the proportion of 100 ml of honey per 40 g of powder from insects. Medvedka is collected, thoroughly washed and dried, protected from light, ground into powder in a blender or crushed in a mortar. For a three-month period, you need to eat 3 tablespoons of the product three times a day before meals.

To treat tuberculosis with garlic, you can make jam from this vegetable or water infusion. Due to the strong antibacterial properties of garlic, it is necessary to eat one clove every couple of hours.

Very effective treatment with animal fat, namely badger or bear. This product can be consumed both in pure form and mixed with honey. Siberian healers recommend to carry out such procedures in the morning and in the evening for a tablespoon.

Conclusion

Tuberculosis is a dangerous and complex disease that can be cured today. The main method used for healing today is still medication. At the same time, it is not only necessary to take the drugs of the schemes proposed by the doctors, but also to undergo concomitant treatment and enhance the effect with alternative methods and folk remedies. Since each case of the disease is unique, only a phthisiatrician can choose the most successful treatment.