Infectious diseases. Treatment of tuberculosis (most important)

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Infectious diseases. Treatment of tuberculosis (most important)

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56. Treatment of tuberculosis

Anti-tuberculosis drugs. Isoniazid is the drug of choice in the treatment of all forms of tuberculosis, prescribed for all therapeutic regimens, if pathogens remain sensitive to it. Side effects of the drug are rare.

Rifampicin is a broad-spectrum antibiotic that is available for oral use and is prescribed in the most active phase of the tuberculous process once a day at a dose of 1-15 mg/kg. The side effect of the drug is expressed by orange staining of teeth, urine and saliva, symptoms of the gastrointestinal tract, toxic changes in the liver, especially in the first weeks of therapy.

Ethambutol has an effect only on mycobacteria. The drug is administered orally 1 time per day at a dose of 15-20 mg/kg. A side effect is expressed by reversible visual impairment - narrowing of the visual fields and a change in the perception of color. Ethambutol can serve as a substitute for isoniazid in combination with streptomycin in cases of isoniazid drug resistance.

Streptomycin is significantly less effective against Mycobacterium tuberculosis than isoniazid and rifampicin, but is superior in this regard to ethambutol. In severe forms of tuberculosis, streptomycin is administered intramuscularly once a day at a dose of 1 mg / kg along with isoniazid and rifampicin during the first few months of therapy. Most often, the side effect is manifested by a violation of the function of the VIII pair of cranial nerves, especially their vestibular department.

Pyrazinamide, administered simultaneously with isoniazid, has a bactericidal effect on Mycobacterium tuberculosis. The drug is administered orally, its daily dose (30-40 mg / kg) is divided into 2-3 doses. The disadvantages of the drug are the tendency to more rapid development of drug resistance.

Ethionamide has a pronounced effect on Mycobacterium tuberculosis, is prescribed in combination with other drugs in the treatment of relapses of the disease and the ineffectiveness of standard chemotherapy regimens. The drug is taken orally 1 time per day at a dose of 15 mg / kg.

Monotherapy. Isoniazid chemoprophylaxis is indicated for all apparently healthy individuals younger than 35 years of age with positive tuberculin tests, who have no changes on chest radiographs or have traces of past tuberculosis. To prevent reactivation of the infection with the development of a general disease, such persons are recommended treatment for 12 months. Prophylactic monotherapy with isoniazid can also be given to children at high risk of developing tuberculosis. Treatment in such cases is prescribed even for children with a tuberculin-negative reaction. The usual practice is to give isoniazid for 3 months and then repeat tuberculin tests. If a turn occurs, then treatment is continued for up to 12 months.

Treatment regimens with two and three drugs. Most cases of tuberculosis in children respond well to treatment with a dual combination of anti-tuberculosis drugs. The most commonly used isoniazid and rifampicin, less often - ethambutol.

Author: Pavlova N.V.

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