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Preventive treatment of tuberculosis
Last reviewed: 23.04.2024
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Preventive treatment of tuberculosis in order to prevent tuberculosis appoints phthisiopathy. This section of work should be a priority in the work of the phthisiopaediatric service. Preventive treatment is given to children and adolescents who have been infected for the first time with an MBT (a turn, an early period of latent tuberculosis infection), and also from high-risk groups for tuberculosis.
When the bend is established, the child is sent to the TB specialist who is observing the patient for 1 year. After an early period of primary tuberculosis infection, the child remains infected with MBT (if there are no risk factors for tuberculosis, provided timely chemoprophylaxis is provided) or local tuberculosis develops at different times after primary infection (depending on the massiveness, virulence of the MTBT and the state of the macroorganism).
The organization of preventive treatment is carried out in different ways depending on the risk factors for the disease. In the presence of specific risk factors (absence of BCG, contact with a sick tuberculosis) preventive treatment is mandatory in a hospital or sanatorium, in other cases, the volume and location of preventive treatment is determined individually.
- Primary prophylaxis of tuberculosis is the provision of preventive treatment for uninfected children and adolescents who have contact with a sick tuberculosis (IV group of dispensary records at a phthisiatrician).
- Secondary prophylaxis of tuberculosis is the provision of preventive treatment of infected children and adolescents by the results of mass tuberculin-diagonism (group VI clinics at the phthisiatrician).
Indications for prescribing preventive treatment with antibacterial drugs
The following indications for prescribing preventive treatment with antibacterial drugs have been determined.
- Children and adolescents infected with tuberculosis:
- in the early period of primary tuberculosis infection (the turn of tuberculin samples) without local changes;
- in the early period of primary tuberculosis infection (the turn of tuberculin samples) with hyperergic reaction to tuberculin;
- with an increase in sensitivity to tuberculin;
- with hyperergic sensitivity to tuberculin;
- with monotonous sensitivity to tuberculin in combination with risk factors for tuberculosis.
- Children and adolescents in contact with tuberculosis patients.
The approach to preventive treatment of children from risk groups for tuberculosis should be individual, taking into account epidemiological and social risk factors.
It should be remembered that chemoprophylaxis with one anti-tuberculosis drug (isoniazid or fiativazid, or metazide at age dosages) in outpatient settings can be performed in children from IV, VI-A, VI-B groups only in the absence of additional (specific or nonspecific) factors risk for the development of the disease. Contact with a sick tuberculosis in an infected child and the presence of other risk factors are the most threatening indicators that contribute to the development of tuberculosis. Preventive therapy for these children should be carried out with two anti-TB drugs in the conditions of children's specialized institutions. In the presence of allergic diseases in patients observed, prophylactic treatment is performed against the background of desensitizing therapy.
Chemoprophylaxis for children is prescribed for 3 months, preventive treatment is carried out individually, depending on risk factors, from 3 to 6 months.
Control over the effectiveness of chemoprophylaxis (preventive treatment) is carried out by clinical and laboratory indicators and tuberculin diagnostics. The decrease in susceptibility to tuberculin, satisfactory clinical and laboratory indicators and absence of disease testify to the effectiveness of preventive measures. Further increase in sensitivity to tuberculin or negative dynamics of clinical and laboratory indicators is an indication for a more thorough examination of the child for tuberculosis.
In the process of monitoring a child from the risk group for tuberculosis in conditions of TB dispensaries, it must be remembered that the course of tuberculosis infection, as well as prolonged treatment of children with anti-tuberculosis drugs, helps to reduce the protective forces of the organism and leads to an increase in the somatic morbidity. Increase the resistance of the body and reduce the risk of tuberculosis incidence by creating a specific immunity against the most common non-specific diseases at this age.
This goal is achieved in the following way: in the body of the child during the preventive chemotherapy with anti-tuberculosis antibacterial drugs, local immunostimulants are administered and seasonal vaccine prophylaxis against influenza and pneumococcal infection is carried out in the group of often ill children or in the presence of other nonspecific risk factors.
Phthisiatricians and pediatricians of general medical practice must remember that carrying out other preventive vaccinations during the treatment of latent tuberculosis infection is prohibited!
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